Form Ict-4 - Electricity Distribution And Invested Capital Tax Return
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1
2Illinois Department of Revenue
Station no. 070
REV 2 Form 491
ICT-4
Electricity Distribution and Invested Capital Tax Return
E S ___/___/___
NS
DP
CA
Do not write above this line.
Identify your business
Calendar year for which you
are filing this return: __ __ __ __
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
Check here if your address has changed.
Federal Employer Identification number (FEIN):
__ __ -__ __ __ __ __ __ __
Is this a final (you are no longer in business)
Invested Capital Tax (ICT) License no.: ___ ___ - ___ ___ ___ ___ ___
return?
yes
no
Business name: __________________________________________________
Daytime telephone: (__ __ __)__ __ __-__ __ __ __
Business address :________________________________________________
Number and street
_______________________________________________________________
City
State
ZIP
Step 1: Figure your Invested Capital Tax
Column A
Column B
Balance at beginning of year
Balance at end of year
1
1
1
Total amount of proprietary capital, stockholders’ equity, or total equity
_____________|_____
_____________|_____
2
2
2
Total long-term debt
_____________|_____
_____________|_____
3
3
3
Add Lines 1 and 2.
_____________|_____
_____________|_____
4
4
4
Investments in and advances to all corporations
_____________|_____
_____________|_____
5
5
5
Subtract Line 4 from Line 3.
_____________|_____
_____________|_____
6
6
Add Column A, Line 5, and Column B, Line 5.
_____________|_____
7
7
Multiply Line 6 by 50% (.50). This amount is the average of the balances.
_____________|_____
.
8
8 ___
Illinois apportionment factor shown on your business income tax return.
______________
9
9
Multiply Line 7 by Line 8.
_____________|_____
10
10
Multiply Line 9 by .8% (.008).
_____________|_____
11
If you are required to complete Worksheet A on the back of this return, write
.
11 ___
the amount from Worksheet A, Line g. If not, write “1.00.”
______________
12
12
Multiply Line 10 by Line 11. This amount is your Invested Capital Tax due.
_____________|_____
Step 2: Figure your Electricity Distribution Tax
(for liabilities on or after January 1, 1998)
13
13
Kilowatt-hours (kwh) distributed
__________________
14
14
Amount from Worksheet B, Line i. This is your Electricity Distribution Tax due.
_____________|_____
Step 3: Figure your payment
15
15
Add Lines 12 and 14. This amount is your tax due.
_____________|_____
16
16
Estimated payments
_____________|_____
17
17
If Line 16 is greater than Line 15, figure your overpayment by subtracting Line 15 from Line 16.
_____________|_____
18
18
If Line 16 is less than Line 15, figure your underpayment by subtracting Line 16 from Line 15.
_____________|_____
19
19
Credit you wish to apply.
_____________|_____
20
20
Subtract Line 19 from Line 18, and pay this amount.
_____________|_____
Make your check payable to “Illinois Department of Revenue.”
Step 4: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
__________________________________________________________________
____/____/________ (____)____-____________
Taxpayer’s signature
Date
Telephone (Include area code.)
__________________________________________________________________
____/____/________ (____)____-____________
Preparer’s signature
Date
Telephone (Include area code.)
Step 5: Mail your return
*249101110*
INVESTED CAPITAL TAX
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
ICT-4 (R-11/12)
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information is
required. Failure to provide information may result in this form not being processed and may result in a penalty.
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