Form Ds-1 - Dry-Cleaning Solvent Tax Return (2006)
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Illinois Department of Revenue
FORM 160 REV 02
DS-1
E S
___/___/___
Dry-Cleaning Solvent Tax Return
NS
DP
CA
RC
Step 1: Identify your business
Do not write above this line.
1
3
Name ______________________________________________
IBT no. ___ ___ ___ ___ ___ ___ ___ ___
Illinois business tax number
2
4
Address ____________________________________________
This return is for the quarter ending ___ ___ ___ ___ ___
Number and street
Month
Year
___________________________________________________
City
State
ZIP
Step 2: Figure your tax on sales of dry-cleaning solvents
5
For chlorine-based solvents
a
5a
Write the number of gallons sold.
_______________________
b
5b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
c
5c
Subtract Line 5b from Line 5a.
_______________________
d
5d
Multiply Line 5c by $10.00. This is your tax on chlorine-based solvents.
$______________________
6
For petroleum-based solvents
a
6a
Write the number of gallons sold.
_______________________
b
6b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
c
6c
Subtract Line 6b from Line 6a.
_______________________
d
6d
Multiply Line 6c by $2.00. This is your tax on petroleum-based solvents.
$______________________
7
For green solvents sold that are not for use in virgin facilities
a
7a
Write the number of gallons sold.
_______________________
b
7b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
c
Subtract Line 7b from Line 7a. This is your net gallons sold
7c
subject to tax.
_______________________
d
7d
Multiply Line 7c by $1.75. This is your tax on these solvents.
$______________________
8
For green solvents sold for use in virgin facilities
a
8a
Write the number of gallons sold.
_______________________
b
8b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
c
Subtract Line 8b from Line 8a. This is your net gallons
8c
subject to tax.
_______________________
d
8d
Multiply Line 8c by $0.35. This is your tax on these solvents.
$______________________
Step 3: Figure your tax on purchases of dry-cleaning solvents
9
Write the number of gallons of chlorine-based solvents
9
purchased from an unregistered out-of-state supplier.
_______________________
10
10
Multiply Line 9 by $10.00. This is your tax on chlorine-based solvents.
$______________________
11
Write the number of gallons of petroleum-based solvents
11
purchased from an unregistered out-of-state supplier.
_______________________
12
12
Multiply Line 11 by $2.00. This is your tax on petroleum-based solvents.
$______________________
13
Write the number of gallons of green solvents purchased from an unregistered
13
out-of-state supplier and which are not for use in a virgin facility.
_______________________
14
14
Multiply Line 13 by $1.75. This is your tax on these solvents.
$______________________
15
Write the number of gallons of green solvents purchased from an
15
unregistered out-of-state supplier for use in a virgin facility.
_______________________
16
16
Multiply Line 15 by $0.35. This is your tax on these solvents.
$______________________
Step 4: Figure your total tax
17
Add Lines 5d, 6d, 7d, 8d, 10, 12, 14, and 16. This is your total payment
17
due. Make your check payable 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.
_______________________________________________________
______________________________________________________
Taxpayer's signature
Telephone
Date
Tax preparer's signature
Telephone
Date
Mail this return and payment to: Dry-Cleaning Solvent Tax, Illinois Department of Revenue, PO BOX 19034, Springfield IL 62794-9034
This form is authorized by the Dry Cleaner Environmental Response Trust Fund Act. 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-492-3783
DS-1 front (R-06/06)
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