Form Mc-1-X-V - Illinois Payment Voucher For Amended Medical Cannabis Cultivation Privilege Tax

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We encourage you to pay electronically using MyTax Illinois. If you make your payment
electronically do not file this form.
If you do not elect to pay electronically, pay the amount you owe on your Form MC-1-X,
Amended Medical Cannabis Cultivation Privilege Tax Return, using the MC-1-X-V at the
bottom of this page.
Complete the MC-1-X-V below, and send it, along with your payment, to the address on
the voucher.
Illinois Department of Revenue
MC-1-X-V
Payment Voucher for Amended Medical Cannabis Cultivation Privilege Tax
(N-05/15)
Reporting Period: __ __ / __ __ __ __
Month
Year
Account ID: __ __ __ __ __ __ __ __
.
00
$
License no.: MC - __ __ __ __ __
Payment amount
Business name ____________________________________
Mail this form and your payment to:
Street address ____________________________________
SPRINGFIELD CASHIERING OPERATIONS
ILLINOIS DEPARTMENT OF REVENUE
City, State, ZIP ____________________________________
PO BOX 19018
SPRINGFIELD IL 62794-9018
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