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Illinois Department of Revenue
ST-2-DP
REV
01
Direct Pay Multiple Site Form
FORM 009
Attach to Form ST-1.
Do not write above this line.
____________________
Account ID:
This form is for __________________________
(Reporting period)
Part 1 —
County locations and municipal locations (no business district tax)
You must round your figures to whole dollars. See instructions.
General merchandise
4a _____________________ X _____ = 4b _________________
Location code
_____________________________________
(rate)
Food, drugs, and medical appliances
Site name
_____________________________________
5a _____________________ X _____ = 5b _________________
Site address
_____________________________________
(rate)
_____________________________________
City, state, ZIP
_____________________________________
General merchandise
4a _____________________ X _____ = 4b _________________
Location code
_____________________________________
(rate)
Food, drugs, and medical appliances
Site name
_____________________________________
5a _____________________ X _____ = 5b _________________
Site address
_____________________________________
(rate)
_____________________________________
City, state, ZIP
_____________________________________
General merchandise
4a _____________________ X _____ = 4b _________________
Location code
_____________________________________
(rate)
Food, drugs, and medical appliances
Site name
_____________________________________
5a _____________________ X _____ = 5b _________________
Site address
_____________________________________
(rate)
_____________________________________
City, state, ZIP
_____________________________________
General merchandise
Location code
_____________________________________
4a _____________________ X _____ = 4b _________________
(rate)
Food, drugs, and medical appliances
Site name
_____________________________________
5a _____________________ X _____ = 5b _________________
Site address
_____________________________________
(rate)
_____________________________________
City, state, ZIP
_____________________________________
General merchandise
4a _____________________ X _____ = 4b _________________
Location code
_____________________________________
(rate)
Food, drugs, and medical appliances
Site name
_____________________________________
Site address
_____________________________________
5a _____________________ X _____ = 5b _________________
(rate)
_____________________________________
City, state, ZIP
_____________________________________
Page totals
4a _____________________
4b _________________
5a _____________________
5b _________________
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
ST-2-DP (R-02/08)
is required. Failure to provide information may result in this form not being processed and may result in a penalty.