Illinois Department of Revenue
 
        ST-2-X   Amended Multiple Site Form                                                                                                                  
        Attach to Form ST-1-X.                                                                                                                                 REV  001    
                                                                                                                                                               FORM 010
                                                                                                                                                               Do not write above this line.
Account ID: ____ ____ ____ ____  -  ____ ____ ____ ____                      Business name:  ___________________________________

Reporting period you are amending: __ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __  
                            Month    Day       Year                          Month    Day      Year
Write the figures that should have been filed.  You must round your figures to whole dollars.                Base (a)  X  rate = tax (b)   

Site where taxable sales were made
                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =                                           4b ________________  
Site name        _____________________________________                                                                                                (rate)
Site address     _____________________________________                       Food, drugs, and medical appliances
                                                                               5a  _______________    X   _______  =  5b                                             ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________

                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =  4b                                             ________________  
Site name        _____________________________________                                                                                                (rate)
                                                                             Food, drugs, and medical appliances
Site address     _____________________________________                         5a  _______________    X   _______  =  5b                                             ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________  

                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =  4b                                             ________________  
Site name        _____________________________________                                                                                                (rate)
                                                                             Food, drugs, and medical appliances
Site address     _____________________________________                         5a  _______________                                               X   _______  =  5b  ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________  

                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =  4b                                             ________________  
Site name        _____________________________________                                                                                                (rate)
                                                                             Food, drugs, and medical appliances
Site address     _____________________________________                         5a  _______________    X   _______  =  5b                                             ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________  

                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =  4b                                             ________________  
Site name        _____________________________________                                                                                                (rate)
                                                                             Food, drugs, and medical appliances
Site address     _____________________________________                         5a  _______________    X   _______  =  5b                                             ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________

                                                                             General merchandise
Location code    _____________________________________                         4a  _______________    X   _______  =  4b                                             ________________  
Site name        _____________________________________                                                                                                (rate)
                                                                             Food, drugs, and medical appliances
Site address     _____________________________________                         5a  _______________    X   _______  =  5b                                             ________________ 
                                                                                                                                                      (rate)
                 _____________________________________                       Receipts taxed at other rates
City, state, ZIP _____________________________________                         8a  _______________                                                             8b    ________________ 

                                                                                                                                                *901011110*
        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-2-X (R-05/09)                   Printed by the authority of the state of Illinois - Web only, One copy