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              Illinois Department of Revenue 

	             ST-1-X				Amended Sales and Use Tax and E911 Surcharge Return
	                                                                                                                                                     				
                                                                                                                                                      REV	08		FORM	003	Station	820,	833
	                                                                                                                                                     E	S			____/___/____	
                                                                                                                                                      NS				DP				CA				RC
                                                                                                                                                      Do not write above this line.
General Information 
Everyone	must	complete	Steps	1,	2,	4,	and	5.	                  	      	                         Amount you are paying: $
You	must	also	complete	Step 3	if	you	believe	that	you	have	overpaid.	                           Make your check payable to "Illinois Department of Revenue."

Step 1: Identify your business.

1   Account	ID:	____	____	____	____		-		____	____	____	____		           	                      3  Business	name:	_________________________________
	              							
2   Reporting	period	you	are	amending:	__	__/__	__/__	__	__	__	through	__	__/__	__/__	__	__	__																																			 	                                       																
	   	          	       	     	 																		Month			Day						Year																									Month			Day						Year
               	
Step 2: Mark the reason why you are filing an amended return.

1____	Overpaid	(Complete	Step	3)			     	                      	      	                        3____ Response	to	notice	or	bill	
		      
2____ Underpaid	                                                                               	4____ Corrections	to	line	items	but	no	additional	tax	due	
                       														
Step 3: Mark the reason(s) why you have overpaid your return.
 
If you collected the overpaid Sales Tax, E911 Surcharge, or ITAC Assessment from your customer(s), 
you must have unconditionally refunded the overpaid amount to your customer(s) before you file a 
claim for credit.
1 ___I	am	decreasing	Line	1	 	I	am	increasing	Line	2	becauseor                                   4 ___I	used	the	wrong	tax	rate.
						 I	sold	merchandise	                                                                       5 ___The	tax	base	is	correct	but	I	put	it	on	the	wrong	tax	line.
    		 a	___to	another	Illinois	business	for	resale.	List	the	account                            6	___I	made	a	math	error	calculating	Lines	9,11,15,	20,	23,	or	25.
													  ID(s)	on	Schedule	RE	and	attach	to	Form	ST-1-X.                                   7 ___I	failed	to	take	the	discount	or	made	a	math	error	calculating																							
					  b	___to	an	out-of-state	customer	and	it	was	delivered	to	a		                            	   		the	discount.
	      	 				location	outside	Illinois.                                                          8	___I	made	errors	completing	Form	ST-2,	Multiple	Site	Form.
						 c	___to	an	exempt	organization.	List	the	tax	exempt	(E)                                 		 	___I	am	a	retailer	who	is	exchanging	Manufacturer's	Purchase	9
	      	 					number(s)	on	Schedule	RE	and	attach	to	Form	ST-1-X.	                             	   		Credit	from	a	customer	for	cash	previously	paid.	
						 d	___that	qualifies	for	a	tax	exemption	for	machinery	or	                               10	___I	overpaid	use	tax	because	I	failed	to	use	Manufacturer's	
               equipment	used	in	manufacturing,	farming,	or	graphic	                           	   		Purchase	Credit	to	pay	use	tax.
               arts.
                                                                                               11 ___I	overpaid	use	tax	because	the	item
				   e	___that	qualifies	for	an	enterprise	zone	exemption.
                                                                                               											 	___qualifies	for	a	tax	exemption	for	machinery	or	equipment	a
			    f		___that	was	returned	by	my	customer.	
                                                                                                      used	in	manufacturing,	farming,	or	graphic	arts.
				   g	___and	paid	tax	that	is	represented	by	amounts	that	have	
                                                                                               	   		 	___qualifies	for	an	enterprise	zone	exemption.b
               become	worthless	as	uncollectible	debt.	
                                                                                               	   		 	___was	shipped	to	and	used	at	a	site	outside	Illinois.c
2	___I	included	receipts	from	prior	month(s)	or	used	the	wrong			
	      month's	receipts.	                                                                      	   		 	___was	returned	to	my	supplier.d
3 ___I	failed	to	include	tax	collected	in	Line	2.	

Turn page to complete Steps 4 and 5.

               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.		
ST-1-X	(R-12/21)             Printed	by	the	authority	of	the	state	of	Illinois	-	Web	only,	One	copy                                                   *00305211G*



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Step 4: Correct your financial information.
Complete	all	applicable	lines.                                                                                                   Figures	as	they	should
Please	round	to	the	nearest	whole	dollar.                                                                                         have	been	filed
Alcoholic Liquor Purchases
  A	  Total	dollar	amount	of	alcoholic	liquor	purchased	(invoiced	and	delivered)	                                           A	   __________|___
Taxable Receipts
  1	  Total	receipts	(Include	tax.)		                                                                                       1	   __________|___
  2   Deductions	-	include	tax	collected	(From	Schedule	A-X,	Line	30)	                                                      2	   __________|___
  3	  Taxable	receipts	(Subtract	Line	2	from	Line	1.)	                                                                      3	   __________|___
Tax on Receipts
Sales	from	locations	within	Illinois
  4a  General	merchandise	tax	base	                                                                                         4a	  __________|___
  4b  General	merchandise	tax	-	Multiply	Line	4a	by	your	tax	rate	of	_______.0.000                                          4b	  __________|___
  5a 	Food,	drugs,	and	medical	appliances	tax	base	                                                                         5a	  __________|___
  5b  Food,	drugs,	and	medical	appliances	tax	-	Multiply	Line	5a	by	your	tax	rate	of	_______.	0.000                         5b	  __________|___
	 Sales	from	locations	outside	Illinois
  6a  General	merchandise	tax	base	                                                                                         6a	  __________|___
  6b  General	merchandise	tax	-	Multiply	Line	6a	by	6.25	percent	(.0625).	                                                  6b	  __________|___
  7a	 Food,	drugs,	and	medical	appliances	tax	base	                                                                         7a	  __________|___
  7b  Food,	drugs,	and	medical	appliances	tax	-	Multiply	Line	7a	by	1	percent	(.01).	                                       7b	  __________|___
Sales	at	prior	rates
  8a  Receipts	at	other	rates	tax	base	                                                                                     8a	  __________|___
  8b  Receipts	at	other	rates	tax	-	Multiply	Line	8a	by	the	applicable	tax	rate.                                            8b	  __________|___
  9	  Tax	due	on	receipts	(Add	Lines	4b,	5b,	6b,	7b,	and	8b.)	                                                              9	   __________|___
Retailer's Discount and Net Tax Due on Receipts
 10	  Discount	(See	instructions.)	                                                                                         10	  __________|___
 11   Net	tax	due	on	receipts	(Subtract	Line	10	from	Line	9.)	                                                              11	  __________|___
Tax on Purchases
 12a  General	merchandise	tax	base	                                                                                         12a	 __________|___
 12b  General	merchandise	tax	-	Multiply	Line	12a	by	6.25	percent	(.0625).	                                                 12b	 __________|___
 13a  Food,	drugs,	and	medical	appliances	tax	base	                                                                         13a	 __________|___
 13b  Food,	drugs,	and	medical	appliances	tax	-	Multiply	Line	13a	by	1	percent	(.01).	                                      13b	 __________|___
 14a  Purchases	at	other	rates	tax	base                                                                                     14a	 __________|___
 14b  Purchases	at	other	rates	tax	-	Multiply	Line	14a	by	the	applicable	tax	rate.	                                         14b	 __________|___
 15   Tax	due	on	purchases	(Add	Lines	12b,	13b,	and	14b.)	                                                                  15	  __________|___
Net Tax Due
 16	  Tax	due	from	receipts	and	purchases	(Add	Lines	11	and	15.)	                                                           16	  __________|___
 16a	 Manufacturer's	Purchase	Credit	(See	instructions.)	                                                                   16a	 __________|___
 17   Prepaid	sales	tax	(See	instructions.)	                                                                                17	  __________|___
 18   Quarter-monthly	(accelerated)	payments	                                                                               18	  __________|___
 19   Total	prepayments	(Add	Lines	16a,	17,	and	18.)	                                                                       19	  __________|___
 20	  Net	tax	due	(Subtract	Line	19	from	Line	16.)	                                                                         20	  __________|___
Payment Due
 21   E911	Surcharge	and	ITAC	Assessment	(From	Schedule	B-X,	Line	10.)	                                                     21	  __________|___
 22		 Excess	tax,	surcharge,	and	assessment	collected	                                                                      22	  __________|___
 23   Total	tax,	surcharge,	and	assessment	due	(Add	Lines	20,	21,	and	22.)	                                                 23	  __________|___
 24   Credit	amount	(See	instructions.)	                                                                                    24	  __________|___
 25   Subtract	Line	24	from	Line	23.	This	is	the	net	total	due.	                                                            25	  __________|___
 26   Enter	the	total	amount	you	have	previously	paid.	                                                                     26	  __________|___
	 	 Compare	Line	25	and	Line	26.
      If	Line	26	is	greater than	Line	25	enter	the difference	on	Line	27.	
      •	 If	Line	26	is	less than	Line	25	enter	the	difference	on	Line	28.
	27   Overpayment	-	This	is	the	amount	you	have	overpaid. Go	to	Step	5	and	sign	this	return.            	                   27	  __________|___
 28   Underpayment	-	This	is	the	amount	you	have	underpaid. Please	pay	this	amount.	Enter	this	amount	on	Page	1.	           28	  __________|___
	 	 Go	to	Step	5	and	sign	this	return.	                                                                                     		    
    Make your payment to “Illinois Department of Revenue.”

Step 5: 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.	Under	
penalties	of	perjury,	I	state	that	I	have	unconditionally	refunded	to	my	customer(s)	any	overpaid	sales	tax,	E911	Surcharge,	and	ITAC	
Assessment	that	I	collected	from	my	customer(s)	and	am	claiming	as	an	overpayment	on	this	return.		

_______________________________________________________   _______________________________________________________
Taxpayer	 																																Phone																																			Date	 						Preparer	 													Phone	 	 	   Date
Mail to: 	 ILLINOIS	DEPARTMENT	OF	REVENUE	
															SPRINGFIELD	IL	62736-0001

ST-1-X	(R-12/21)                                                                                                            *00305212G*



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Account	ID:	____	____	____	____		-		____	____	____	____			

Reporting	period	you	are	amending:	__	__/__	__/__	__	__	__	through	__	__/__	__/__	__	__	__
	                           Month	              Day	 Year	          Month	 Day	   Year
Schedule A-X — Amended Deductions                                                                           Figures	as	they
                                                                                                            should	have	been	filed
Section 1: Taxes and miscellaneous deductions
If no Section 1 deductions, go to Section 2.
  1   Taxes	collected	on	general	merchandise	sales	and	service		1		                                         _____________|_____
  2   Taxes	collected	on ood,	drugs,	and	medical	appliances	sales	f and	service	  		2                   		  _____________|_____
  3   E911	Surcharge	and	ITAC	Assessment	collected		3		                                                     _____________|_____
  4	  Resale                                                                                           4		  _____________|_____
  5	  Interstate	commerce                                                                              5		  _____________|_____
  6		 Manufacturing	machinery	and	equipment	(MM&E)	-	Do	not	include	graphic	arts.	                     6		  _____________|_____
  7		 Farm	machinery	and	equipment	                                                                  	 7		  _____________|_____
  8   Graphic	arts	machinery	and	equipment -	Do	     not	combine	with	deduction	for	MM&E	on	Line	6.	   8		  _____________|_____
	 9   Supplemental	Nutrition	Assistance	Program	(SNAP	-	formerly	called	food	stamps)	                  9		  _____________|_____
	 	10 Enterprise	zone
    a Sales	of	building	materials	                                                                   	10a		 _____________|_____
		 	b Sales	of	items	other	than	building	materials	                                                  	10b		 _____________|_____
	 	11 High	impact	business		
    a Sales	of	building	materials	                                                                   	11a		 _____________|_____
		 	b Sales	of	items	other	than	building	materials	                                                  	11b		 _____________|_____
	 	12 River	edge	redevelopment	zone	building	materials	                                              	12		  _____________|_____
	13   Exempt	organizations                                                                            13		  _____________|_____
 14	  Uncollectible	debt	on	which	tax	was	previously	paid                                             14		  _____________|_____
 15   Sales	of	service	-	Identify	here:	____________________		                                       15		   _____________|_____
 16		 Other	(including	cash	refunds,	newspapers	and	magazines,	etc.)	-	Identify	below.
	  	 _________________________________________________			                             	              16		   _____________|_____
 17   Total	Section	1	deductions.	Add	Lines	1	through	16.	                            	              17		   _____________|_____
Section 2: Motor fuel deductions - If no Section 2 deductions, go to Section 3.
	    State motor fuel tax
 18   Gasoline	-	number	of	gallons	                                                                   18a		 ___________________
	 	 Multiply	Line	18a	by	the	applicable	rate.	(See	Instructions.)	                                    18b   _____________|_____
	 	19 Gasohol	and	majority	blended	ethanol		-	number	of	gallons	                                      19a   ___________________
	 	 Multiply	Line	19a	by	the	applicable	rate.	(See	Instructions.)	                                    19b   _____________|_____	
	 	20 Diesel	(including	biodiesel	and	biodiesel	blends)		-	number	of	gallons	                         20a   ___________________
	 	 Multiply	Line	20a	by	the	applicable	rate.	(See	Instructions.)	                                    20b   _____________|_____
	 	21 Dieselhol	and	other	fuels	at	diesel	rate	-	number	of	gallons	                                   21a   ___________________
	 	 Multiply	Line	21a	by	the	applicable	rate.	(See	Instructions.)                                     21b   _____________|_____
	 	22 Liquefied	natural	gas	and	liquefied	petroleum	gas		-	number	of	DGEs	                            22a   ___________________
	 	 Multiply	Line	22a	by	the	applicable	rate.	(See	Instructions.)	                                    22b   _____________|_____
	23	  Compressed	natural	gas	and	other	fuels	at	gasoline	rate	-	number	of	GGEs	                       23a   ___________________
	 	 Multiply	Line	23a	by	the	applicable	rate.	(See	Instructions.)	                                    23b   _____________|_____
      Specific fuels sales tax exemption
	 	24 Biodiesel	blend	(no	less	than	1%	but	no	more	than	10%	biodiesel)	-	total	receipts	              24a   _____________|_____
	 	 Multiply	Line	24a	by	20%	(.20).	                                                                  24b   _____________|_____
	 	25 Biodiesel	blend	(more	than	10%	but	no	more	than	99%	biodiesel)	-	total	receipts	                25a   _____________|_____
		    Multiply	Line	25a	by	100%	(1.00).                                                               25b   _____________|_____
	 	26 100	percent	biodiesel	-	total	receipts	                                                         26a   _____________|_____
	 	 Multiply	Line	26a	by	100%	(1.00).                                                                 26b   _____________|_____
	 	27 Majority	blended	ethanol	fuel	-	total	receipts	                                                 27a   _____________|_____
	 	 Multiply	Line	27a	by	100%	(1.00).                                                                 27b   _____________|_____
 28		 Other	motor	fuel	deductions:	________________________________			                               28		   _____________|_____
 29   Total	Section	2	deductions.	Add	Lines	18b	through	27b	and	28.                                  29		   _____________|_____
Section 3: Total deductions
 30	  Add	Lines	17	and	29.	Enter	these	amounts	on	Step	4,	Line	2.                                    30 		  _____________|_____

ST-1-X	(R-12/21)                                                                                     *00305213G*



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Account	ID:	____	____	____	____		-		____	____	____	____		

Reporting	period	you	are	amending:	__	__/__	__/__	__	__	__	through	__	__/__	__/__	__	__	__	
                               Month			Day							Year       Month				Day							Year

	Schedule B-X — Amended E911 Surcharge and ITAC Assessment                                     Figures	as	they
                                                                                               should have been filed
  Receipts from retail transactions of prepaid wireless telecommunications service
  1	 Enter	receipts	subject	to	E911	Surcharge	and	ITAC	Assessment	                         1		 _____________|_____
  Figure your breakdown of retail transactions for Chicago locations
  2 For	Chicago	locations	                                                                 2a	 _____________|_____
		 Multiply	Line	2a	by	your	rate	of	_______.	0.000                                         2b	 _____________|_____
 3  For	Chicago	locations	at	prior	rates	                                                  3a  _____________|_____
    Multiply	Line	3a	by	your	rate	of	_______.	0.000                                        3b  _____________|_____
  4 Total	for	Chicago.	Add	Lines	2b	and	3b.                                                4	  _____________|_____
  Figure your breakdown of retail transactions for non-Chicago locations
 5  For	non-Chicago	locations	                                                             5a	 _____________|_____
 	 Multiply	Line	5a	by	your	rate	of	_______.	0.000                                         5b	 _____________|_____
 6  For	non-Chicago	locations	at	prior	rates	                                              6a	 _____________|_____
		 Multiply	Line	6a	by	your	rate	of	_______.	0.000                                         6b  _____________|_____
  7 Total	for	non-Chicago	locations.		Add	Lines	5b	and	6b.	                                7	  _____________|_____
Figure your net E911 Surcharge and ITAC Assessment
 8  Total	E911	Surcharge	and	ITAC	Assessment.	Add	Lines	4	and	7.	                          8	  _____________|_____
  9	 Discount	-	If	you	qualify,	multiply	Line	8	by	the	applicable	rate.	See	instructions.  9	  _____________|_____
	10	 Subtract	Line	9	from	Line	8.	Enter	these	amounts	on	Step	4,	Line	21.	                 10  _____________|_____

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ST-1-X	(R-12/21)                                                                           *00305214G*






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