Use your 'Mouse' or the 'Tab' key to move through the fields, except for the "Check Boxes", then you must use the 'Mouse'

      STS-80 (N-8/01)                                                                                                                                                                                                                                                          If you have any questions, please call us at                                                                                                     Mail to: Signature                     ____________________________________              __ __ /__ __/__ __ __ __ the best of my knowledge, it is true, correct, and complete. Under penalties of perjury, I state that I have examined this information and, to Part 3: Signature                                                                                                                                                                                                   Part 2: Vending machine information Telephone number: (______)______ - __________ City, State, ZIP:                                 Street address: __________________________________________________ Name:                                                     Illinois Business Tax number (IBT no.): ___ ___ ___ ___ - ___ ___ ___ ___ Part 1: Business information                                      Note:                                                                    There is no charge for these decals. Vending Machine Decals, to obtain decals that must be affixed to the vending machine. dispensed from a vending machine, you must complete Form STS-80, Request for If you own items that are sold for use or consumption (                            Read this information first
                      information could result in a penalty. This form has been approved by the Forms Management Center.              IL-492-0900 This form is authorized by the Retailers' Occupation Tax Act. Disclosure of this information is REQUIRED. Failure to provide                                                                                                                                                                                                                                                                                                                                                                                                                                     b                                                                             a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Number of decals you are requesting at this time:_________ at retail:________                                                           Total number of vending machines from which you sell items
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            _________________________________________________________                                                                                                        certificate of registration expires. Y our vending machine decals expire at the same time that your sales tax                                                                                                                                                                                                                                                                                                                       STS-80                                Illinois Department of Revenue

                                                                                                                                                                                                                                                                                                                            SPRINGFIELD IL  62794-9030 PO BOX 19030 ILLINOIS DEPARTMENT OF REVENUE CENTRAL REGISTRATION SECTION                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        __________________________________________________
Reset                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Request for Vending Machine Decals

Print                                                                                                                                                                                                                                                                                                                                                                                                                                                              Date
                                                                                                                                                                                                                                                                               217 785-3707.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   i.e., 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   candy, beverages) that are