Form Ict-1 - Electricity Distribution And Invested Capital Tax Estimated Payment Page 3
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1
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3Illinois Department of Revenue
ICT-1
Electricity Distribution & Invested Capital Tax Estimated Payment
Station no: 069
E ___/___/____
Your estimated tax payment due dates are:
Return liability period:
12/ __ __ __ __
Year
March 15, June 15, September 15,
and December 15.
$
1 Estimated Invested Capital Tax
___________________|____
2
$
Estimated Electricity Distrib. Tax
___________________|____
3
$
Account ID: __ __ __ __ __ __ __ __
Add Lines 1 and 2.
___________________|____
4
$
Credit amount
___________________|____
(See instructions.)
5
$
License no.: __ __ - __ __ __ __ __
Total due
___________________|____
(Subtract Line 4 from Line 3.)
Mail this form and your payment to:
Business name _______________________________________
*248901110*
ILLINOIS DEPARTMENT OF REVENUE
Street address
_______________________________________ PO BOX 19019
SPRINGFIELD IL 62794-9019
City, State, ZIP _______________________________________
ICT-1 (R-11/12)
Detach here and send this portion with your payment.
Illinois Department of Revenue
ICT-1
Electricity Distribution & Invested Capital Tax Estimated Payment
Station no: 069
E ___/___/____
Your estimated tax payment due dates are:
Return liability period:
12/ __ __ __ __
Year
March 15, June 15, September 15,
and December 15.
$
1 Estimated Invested Capital Tax
___________________|____
2
$
Estimated Electricity Distrib. Tax
___________________|____
3
$
Account ID: __ __ __ __ __ __ __ __
Add Lines 1 and 2.
___________________|____
4
$
Credit amount
___________________|____
(See instructions.)
5
$
License no.: __ __ - __ __ __ __ __
Total due
___________________|____
(Subtract Line 4 from Line 3.)
Mail this form and your payment to:
Business name _______________________________________
ILLINOIS DEPARTMENT OF REVENUE
*248901110*
Street address
_______________________________________ PO BOX 19019
SPRINGFIELD IL 62794-9019
City, State, ZIP _______________________________________
ICT-1 (R-11/12)
Detach here and send this portion with your payment.
Illinois Department of Revenue
ICT-1
Electricity Distribution & Invested Capital Tax Estimated Payment
Station no: 069
E ___/___/____
Your estimated tax payment due dates are:
Return liability period:
12/ __ __ __ __
Year
March 15, June 15, September 15,
and December 15.
$
1 Estimated Invested Capital Tax
___________________|____
2
$
Estimated Electricity Distrib. Tax
___________________|____
3
$
Account ID __ __ __ __ __ __ __ __
Add Lines 1 and 2.
___________________|____
4
$
Credit amount
___________________|____
(See instructions.)
5
$
License no.: __ __ - __ __ __ __ __
Total due
___________________|____
(Subtract Line 4 from Line 3.)
Mail this form and your payment to:
Business name _______________________________________
*248901110*
ILLINOIS DEPARTMENT OF REVENUE
Street address
_______________________________________ PO BOX 19019
SPRINGFIELD IL 62794-9019
City, State, ZIP _______________________________________
ICT-1 (R-11/12)
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