Form Tp-17 - Other Deductions For Moist Snuff
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Illinois Department of Revenue
TP-17
Other Deductions for Moist Snuff
Read this information first
Do not write above this line.
Attach this schedule to Form TP-1, Tobacco Products Tax Return, when you claim a deduction on Form TP-1, Line 24, for a reason other than
moist snuff sold and shipped in interstate commerce, sales to other distributors, or returned merchandise. Complete this form with a brief
description of the deduction (i.e. weight-based tobacco products sold to a U.S. government agency). Samples are not allowable deductions.
If you need to identify more than 14 invoices, additional Forms TP-17 must be completed. We will accept a computer-generated schedule
as long as we approve its format and content prior to use. To obtain approval, please send a copy of your format to: Office of Publications
Management, Illinois Department of Revenue, 101 West Jefferson Street, MC 3-375, Springfield, Illinois 62702.
Step 1: Identify your business
1
3
Business name
_____________________________________
Account ID: ____ ____ ____ ____ ____ ____ ____ ____
2
4
TP
Address: _____________________________________________
License no.
– ____ ____ ____ ____ ____
Number and street
5
____________________________________________________
For what month are you filing this schedule?
_______/_______
City
State
ZIP
Month
Year
Step 2: Complete the following to support your other deductions
Reason for deduction
Reference or
Date
Number of ounces
invoice number
1 _______________________________________________
_______________ ___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
2 _______________________________________________
_______________ ___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
3 _______________________________________________
_______________ ___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
4 _______________________________________________
_______________ ___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
5 _______________________________________________
_______________ ___/___/___
____________________
Month Day
Year
_____________________________________________________
Complete back page if more
lines are needed in Step 2.
_____________________________________________________
Step 3: Figure your total
Add the ounces of moist snuff from all Forms TP-17 you are filing for the month listed in Step 1.
Transfer this grand total amount to Form TP-1, Step 3, Line 24.
____________________
*294F01110*
TP-17 (N-12/12)
This form is authorized as outlined by the Tobacco Products Tax Act of 1995. Disclosure
of this information is REQUIRED. Failure to provide information could result in penalties.
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