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ST-14-X Amended Chicago Soft Drink

Tax Return
REV 03 FORM 103
E S _____/____/_____
NS DP CA RC
Do not write above this line.
Read this information first

• If you are making a payment with this return,
write the amount you are paying here. $___________________________
Make your payment to “Chicago Soft Drink Tax.”
• If you are claiming an overpayment on this return and you collected the overpaid tax from your customer(s), you must
refund the tax to your customer(s) before filing this return. When you complete this return, you must state, under penalties
of perjury, in Step 4, that you unconditionally refunded the overpaid tax to your customer(s).

Step 1: Identify your business

1 Account ID: ____ ____ ____ ____ - ____ ____ ____ ____
2 Reporting period you are amending: __ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __
Month Day Year Month Day Year
3 Business name _______________________________________

Step 2: Mark the reason why you are filing an amended return.
Check any appropriate lines below.

____1 I took a deduction on my original return that was not allowed 3 ____ I put an amount on the wrong line on Form ST-14.
or was too large. ____4 I overcollected soft drink tax from my customer.
____2 I should have taken a deduction or a larger deduction on my ____5 I made a computational error.
original return because I sold soft drinks 6 ____ The original Account ID number was incorrect. The
a ____ to another Illinois business for resale. correct Account ID number is ___________________.
(Business’ Account ID no. ____________________) 7 ____ The original reporting period was incorrect. The
b ____ to an out-of-state customer, which was a sale in correct reporting period is ______________________.
interstate commerce. The soft drinks were delivered ____8 Other. Please explain. ________________________
to a location outside Illinois. ___________________________________________
c ____ to an exempt organization. ___________________________________________
(Tax-exempt no. E- _________________________) ___________________________________________
d ____ that were returned by my customer. ___________________________________________
e ____ that were exempt for another reason. Please ___________________________________________
explain. ___________________________________ ___________________________________________
_________________________________________ ___________________________________________

Please turn page to complete Parts 3 and 4
This form is authorized by ordinance of the city council of the city of Chicago and by related tax acts.
Disclosure of this information is REQUIRED. Failure to provide information could result in a penalty.

*710331110*

ST-14-X (R-05/17)

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Step 3: Correct your financial information Column A Column B
Please round to the nearest whole dollar. Most recent figures filed Figures as they should
have been filed

1 Enter your total Chicago soft drink receipts. 1 ________________________ 1 ________________________
2 Deductions
a Enter taxes included in Line 1. 2a ________________________ 2a ________________________
b Enter tax-exempt sales included in Line 1. 2b ________________________ 2b ________________________
Add Line 2a and Line 2b. 2 ________________________ 2 ________________________
3 Subtract Line 2 from Line 1. This amount is your taxable receipts. 3 ________________________ 3 ________________________
4 Multiply Line 3 by 3 percent (.03). This is your tax due on receipts. 4________________________ 4 ________________________

5 Enter the amount of your discount. (See instructions.) 5 ________________________ 5 ________________________
6 Subtract Line 5 from Line 4. This is your net tax due. 6 ________________________ 6 ________________________

7 Enter the excess tax collected. 7 ________________________ 7 ________________________
8 Add Lines 6 and 7. This is your tax due. 8 ________________________ 8 ________________________
9 Enter the credit amount. 9 ________________________ 9 ________________________
10 Subtract Line 9 from Line 8. This is your net tax due. 10 ________________________ 10 ________________________
11 Enter the total amount you have paid. 11 ________________________

12 If Line 11 is greater than Line 10, Column B, enter the difference.
This is the amount you have overpaid. Go to Step 4. 12 ________________________
13 If Line 11 is less than Line 10, Column B, enter the difference.
This is the amount you have underpaid. Please pay this amount.
We will bill you for any penalty and interest that is due. Go to Step 4. 13 ________________________

Make your payment to “Chicago Soft Drink Tax.”
Please enter the amount you are paying on the line provided on the front of this return.

Step 4: 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. Under penalties of perjury, I state that I have unconditionally refunded to my customer(s) any overpaid sales tax that I
collected from my customer(s) and am claiming as an overpayment on this return.

( ) -
Owner, partner, or officer’s signature Title Phone Date

( ) -
Paid preparer’s signature Phone Date

Mail to:

CHICAGO SOFT DRINK TAX ADMINISTRATION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19034
SPRINGFIELD IL 62794-9034

*710332110*
ST-14-X (R-05/17)
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