Form St-2-Dp-X - Amended Direct Pay Multiple Site Form

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Illinois Department of Revenue
Rev
Form
ST-2-DP-X
Amended Direct Pay Multiple Site Form
Attach to Form ST-1-X.
Do not write above this line.
Account ID
____ ____ ____ ____ - ____ ____ ____ ____
Business name
___________________________________
This form is for
_______________________________
(Reporting period)
Write the fi gures that should have been fi led. You must round your fi gures to whole dollars.
Base (a) X rate = tax (b)
Site where taxable purchases were made
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
Site name
_____________________________________
4a ________________ X _______ = 4b ________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
_____________________________________
5a ________________ X _______ = 5b ________________
(rate)
City, state, ZIP
_____________________________________
Page totals
4a _____________________
4b _________________
5a _____________________
5b _________________
This form is authorized as outlined by the Illinois Retailers’ Occupation and Related Tax Acts and the Direct Pay Permit Implementation Act. Disclosure of this
ST-2-DP-X (R-9/08)
information is REQUIRED. Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-4099
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