Food Beverage Tax Return Form - North Chicago printable pdf download

CITY OF NORTH CHICAGO

FOOD AND BEVERAGE TAX RETURN

(Effective 10-06)

Must be received by the City or postmarked on or before the 20th of

the calendar month succeeding the end of the month filing period

Calendar Month for Which Tax Return Applies: ____________________________________,_20______

Name of Establishment: ________________________________________________________________

Business Address: ____________________________________________________________________

Phone Number: _______________________________________________________________________

COMPUTATION OF TAX LIABILITY

1. Gross receipts from the sale of prepared food

and alcoholic beverages exclusive of all taxes (Line 3 of ST-1), (Line 4a on ST-2)... $____________________

2. Food and Beverage Tax Liability (Line 1 multiplied by 1.0%)…..…….....….…........... $____________________

3. Penalty: Interest (5.0% of line 2 per month or fraction thereof)….……....……..…….. $____________________

4. Total Due the City of North Chicago (add lines 2 and 3)….…….....…….…….…..….. $____________________

Is the required copy of the State of Illinois Sales Tax Return Form ST-1 or ST-2 attached?....________________

If not, please explain __________________________________________________________________________

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I hereby affirm that the information presented in this return is taken from the books and records of the

above named business and is true and correct to the best of my knowledge.

__________________________________________________________

___________________________

Signature and Title of Individual Preparing Return

Date

__________________________________________________________

___________________________

Print Name of Individual Preparing Return

Telephone #

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Due Date: The completed food and beverage tax return and payment of the tax liability must be

received by the City or postmarked on or before the 20th day of the calendar month succeeding

the end of the month filing period.

The completed tax return and payment should be mailed to:

City of North Chicago

Comptroller's Department – Food and Beverage Tax

1850 Lewis Avenue

North Chicago, IL 60064

Any questions regarding the food and beverage tax should be directed to the Finance Department at 847-596-8620

Forms available at