Form Pst-1-X - Amended Prepaid Sales Tax Return
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Illinois Department of Revenue
PST-1-X
Amended Prepaid
Sales Tax Return
Form 035 Rev 01 Stations 435, 436
E (03) S (04) _ _/_ _/_ _ _ _
NS CA RC
Do not write above this line.
Read this information first
Everyone must complete Parts 1, 2, and 5.
You also must complete
Amount you are paying: $ _______________________________
• Part 3 if you believe you have overpaid, and
Make your check payable to “Illinois Department of Revenue.”
• Part 4 if you are changing financial information.
Part 1: Identify your business
1
IBT no. ____ ____ ____ ____ ____ ____ ____ ____
“X” only if your address is different from the address on your
Illinois business tax number
original return and complete Line 4 below.
2
4
Amended tax period ____________________________________
Mailing address _______________________________________
Number and street
3
Business name________________________________________
______________________________________________________
City
State
ZIP
Part 2: Check the reason you are correcting your return
1
3
____ My customer returned gasohol or other motor fuel.
____ I made a computational error on Lines 3 through 12 of my
original return.
2
____ I am decreasing Line 1 or I am increasing Line 2 on my
4
original return because I sold gallons
____ I put an amount on the wrong line on either Form PST-1 or
a
____ to a federal or foreign government or to a
Form PST-2.
mass transit system.
5
(Tax-exempt no. E -_________________________)
____ I took a deduction on my original return that was
b
____ to an out-of-state customer, which was a sale
not allowed or was too large.
in interstate commerce. The merchandise was
6
delivered to a location outside Illinois.
____ The original IBT number was incorrect. The
c
____ to another licensed Illinois distributor or supplier.
correct IBT number is ___ ___ ___ ___ ___ ___ ___ ___.
(IBT no. ___ ___ ___ ___ ___ ___ ___ ___)
d
7
____ to the state or to units of local government.
____ The original tax period was incorrect. The
(Tax-exempt no. E -_________________________)
correct tax period is _______________________________.
e
____ to schools, churches, or charities.
8
(Tax-exempt no. E -_________________________)
____ Other. Please explain. ______________________________
f
____ to an out-of-state retailer who is authorized to do
_______________________________________________
business out-of-state and who resells at retail and
_______________________________________________
delivers to customers outside Illinois.
_______________________________________________
g
____ of exempt motor fuel ( i.e. , majority-blended ethanol,
_______________________________________________
100 percent biodiesel, and biodiesel blends that
_______________________________________________
are more than 10 percent but not more than 99
_______________________________________________
percent biodiesel) on or after July 1, 2003.
_______________________________________________
h
____ to other than a retail outlet and delivered the
_______________________________________________
gasohol or other motor fuel to a company-owned
_______________________________________________
(not leased) retail outlet.
_______________________________________________
Part 3: Answer the following questions if you believe you have overpaid
1
____
____
Did you collect the overpaid tax from your customer?
yes
no
2
____
____
If yes, did you unconditionally refund the overpaid tax?
yes
no
Please turn this page over to complete Parts 4 and 5.
This form is authorized by the Retailers’ Occupation Tax and related tax
acts.
Disclosure of this information is REQUIRED.
Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3869
PST-1-X (R-9/03)
Page 1 of 4
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