STATUS [ ] For office use only

Transcription

1 CITY OF CHICAGO DEPARTMENT OF REVENUE GROUND TRANSPORTATION TAX US FOR USE BY APPROVED APPLICANTS OF UNDERSERVED AREAS CREDIT PROGRAM ONLY STATUS [ ] For office use only ACCOUNT NUMBER DUE DATE CHECK IF RETURN IS: Mail Payment and Return to: Amended BEGINNING PERIOD ENDING PERIOD MAILING ADDRESS: Number of Sites: BUSINESS ADDRESS: BUSINESS PHONE: Check the following if deposits were: Estimate Actual (If actual, annualization schedule must be attached) If you have any changes to the account information listed on this return please contact Client Consultation of the Department of Revenue at (312) 747-IRIS (4747). Do not fill in cents amount, round up to nearest dollar (if 50 cents or more). Note: List all medallion numbers if you have less than five taxicabs: Taxable Days Tax Rate Tax Due 1. Taxicabs (line 1b of instructions) or fewer passengers (line 2d of instructions) to 24 passengers (line 3d of instructions) or more passengers (line 4d of instructions)... Tax due before underserved credits and current year's payments (add lines 1-4) Underserved area credit (see instructions) Tax due before current year's payments (subtract line 6 from line 5)... STOP AT LINE 7 IF THIS IS AN AMENDED RETURN 8. Current year's tax payments... Page

2 ACCOUNT NUMBER REVISION NUMBER 9. Total tax due (subtract line 8 from line 7). If line 9 is greater than 0, enter the amount owed. If line 9 is less than 0, please skip to line Interest for late payment (line 10c of instructions) Penalty for late payment/filing (see instructions) Total tax, interest, and penalty (add lines 9, 10, and 11) Overpayment. If line 9 is less than 0, enter the amount of overpayment If you want the amount of the overpayment to be credited to next year's estimated tax, check the credit box. Otherwise, check the refund box. Credit Refund NOTE: Any amounts overpaid will first be applied to deficiencies outstanding for this tax and to deficiencies for any other City of Chicago tax for which you are registered. Page

3 ACCOUNT NUMBER REVISION NUMBER MARKING INSTRUCTIONS Use a black or blue ink pen only. Do not use pens with ink that soaks through the paper. Print clearly, using all CAPITAL letters. Owner/Officer Statement Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete. FIRST NAME LAST NAME PHONE NUMBER DATE SIGNATURE (REQUIRED) TITLE Preparer Statement Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete. FIRST NAME LAST NAME PHONE NUMBER DATE AGENT/PAID PREPARER SIGNATURE (REQUIRED) BUSINESS NAME F.E.I.N. PHONE NOTE: YOU MUST FILL THIS FORM OUT COMPLETELY. IF ANY INFORMATION IS OMITTED, THIS RETURN WILL BE DEEMED INCOMPLETE, AND YOU WILL BE ASSESSED ADDITIONAL PENALTIES. ACCOUNT NUMBER MUST BE ENTERED. For DOR Use Only Postmark Date Receipt Number Page

4 ACCOUNT NUMBER INSTRUCTIONS FOR PREPARING THE GROUND TRANSPORTATION TAX RETURN US LINE 1. a. Taxicabs Enter the total number of taxicabs that were used in Chicago during the entire tax year... b. Enter the total number of days each taxicab in line 1a was used in Chicago during the entire tax year... Note: Maximum use per cab could be 365 days EXAMPLE: You own four cabs and throughout the year, one cab was used 250 days, second cab 100 days, the third cab was used 50 days, and the fourth cab was used 100 days. The total number of days used is 500 (250 days days + 50 days days). LINE or fewer passenger capacity vehicles a. Enter the total number of vehicles that were used in Chicago during the entire tax year... b. Enter the total number of days each vehicle in line 2a was used in Chicago... c. Enter the total number of days from line 2b where the vehicles on line 2a were exclusively used in conformity with the exemptions defined in Section of this ordinance... d. Taxable days (subtract line 2c from line 2b)... Note: Maximum use per vehicle could be 365 days EXAMPLE: You own four vehicles and throughout the year, one vehicle was used 250 days, second vehicle 100 days, the third vehicle was used 50 days, and the fourth vehicle was used 100 days. The total number of days used is 500 (250 days days + 50 days days). LINE to 24 passenger capacity vehicles a. Enter the total number of vehicles that were used in Chicago during the entire tax year... b. Enter the total number of days each vehicle in line 3a was used in Chicago... c. Enter the total number of days from line 3b where the vehicles on line 3a were exclusively used in conformity with the exemptions defined in Section of this ordinance... d. Taxable days (subtract line 3c from line 3b)... Note: Maximum use per vehicle could be 365 days EXAMPLE: You own four vehicles and throughout the year, one vehicle was used 250 days, second vehicle 100 days, the third vehicle was used 50 days, and the fourth vehicle was used 100 days. The total number of days used is 500 (250 days days + 50 days days). LINE or more passenger capacity vehicles a. Enter the total number of vehicles that were used in Chicago during the entire tax year... b. Enter the total number of days each vehicle in line 4a was used in Chicago... c. Enter the total number of days from line 4b where the vehicles on line 4a were exclusively used in conformity with the exemptions defined in Section of this ordinance... d. Taxable days (subtract line 4c from line 4b)... Note: Maximum use per vehicle could be 365 days EXAMPLE: You own four vehicles and throughout the year, one vehicle was used 250 days, second vehicle 100 days, the third vehicle was used 50 days, and the fourth vehicle was used 100 days. The total number of days used is 500 (250 days days + 50 days days). Page

5 ACCOUNT NUMBER REVISION NUMBER LINE 5. LINE 6. a. Tax due before underserved credits and current year's payments (add lines 1 through 4)... Calculation of underserved area credit Enter total # of trips to or from underserved areas for the entire tax year (from your entire tax yearly worksheet)... b. Enter total # of trips for the entire tax year (from your entire tax yearly worksheet)... c. Divide line a by line b... d. Multiply line c by the tax calculated on line 5... e. Enter 50 percent of the tax due calculated on line 5... f. LINE 7. LINE 8. Enter the lesser of line d or e--this is your underserved area tax credit... NOTE: Monthly worksheets must be attached for each month during the entire tax year. Tax due before current year's payments (subtract line 6 from line 5)... Current year's tax payment. LINE 9. LINE a. Total tax due (subtract line 8 from line 7). If line 9 is greater than 0, enter the amount owed. If line 9 is less than 0, skip to line 13. Determine the amount of interest owed based on tax past due. Enter number of days late (August 16 being one day late, etc.) b. Enter amount from line c. Total amount of interest (10b * [10a / 365]) * 12%... EXAMPLE: If you determine that you owe $100,000 on the due date (August 15) and you file and pay the tax on August 26, then you are 11 days late in making the payment. The calculation of the interest owed is as follows: [$100,000 * (11/365)] * 12% = $361.64, which is $362 when rounded to the nearest dollar). LINE 11. LINE 12. LINE 13. LINE 14. Late penalties: Compute penalty based on 1 of the 2 requirements listed below: a) If the return is being filed timely, but payment is late, compute 5% of line 9. b) If return is filed late, compute the greater of 1) 1% of line 7 (up to a maximum of $5,000) or 2) 5% of line 9. The tax return is due on or before the 15th day of the second month following the fiscal year in which taxable receipts are received. Enter the total amount of tax, interest, and penalty due to the City of Chicago (add lines 9, 10, and 11). Overpayment. If line 9 is less than 0, enter the amount of overpayment. If you want the amount of the overpayment to be credited to next year's estimated tax, check the credit box. Otherwise, check the refund box. Note: any amounts overpaid will first be applied to deficiencies outstanding for this tax and to deficiencies for any other City of Chicago tax for which you are registered. FOR ADDITIONAL INFORMATION CALL IRIS (4747) (TTY ) NOTE: YOU MUST COMPLETE ALL INFORMATION ON THIS PAGE FOR THIS RETURN TO BE CONSIDERED COMPLETE. Page

6 GROUND TRANSPORTATION VEHICLE WORKSHEET INSTRUCTIONS: COMPLETE ONE WORKSHEET FOR EACH GROUND TRANSPORTATION VEHICLE CHECK MONTH: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC FIRST NAME LAST NAME ACCOUNT NUMBER BUSINESS NAME MEDALLION NUMBER BUSINESS ADDRESS LICENSE PLATE NUMBER CITY STATE ZIP LICENSE HOLDER NAME BUSINESS PHONE CHECK VEHICLE INFO: OWN LEASE Date In Service? Yes No Start Odometer Reading End Odomoter Reading Out-of-Service Code (See Below) # of Trips in Underserved Area Total Trips for Entire Day* 1 X X 02 EXAMPLE PAGE

7 GROUND TRANSPORTATION VEHICLE WORKSHEET INSTRUCTIONS: COMPLETE ONE WORKSHEET FOR EACH GROUND TRANSPORTATION VEHICLE Date In Service? Yes No Start Odometer Reading End Odomoter Reading Out-of-Service Code (See Below) # of Trips in Underserved Area Total Trips for Entire Day* TOTAL DAYS: In Service Out-of- Service TRIP TOTALS 0UT-OF-SERVICE CODES 01 = REPAIR 02 = DID NOT WORK 03 = OTHER (DESCRIBE) Underserved Grand Total Areas (To be forwarded to 7595US tax return) Retain documentation to substantiate the reasons your vehicle was out of service for a particular day (i.e., repair bill, accident report, etc.). Taxpayer Statement Under the penalty of perjury, I certify that the information provided above is true, correct, and complete. FIRST NAME LAST NAME SIGNATURE (REQUIRED) TITLE * IN ORDER TO TAKE A CREDIT FOR MAKING TRIPS TO UNDERSERVED AREAS, DAILY LOGS MUST BE ATTACHED WHICH RECORD ALL TRIPS MADE TO ALL AREAS EACH DAY OF THE MONTH. Page

8 ACCOUNT NUMBER ORIGIN/DESTINATION LOG SHEET DATE TRIP ORIGIN TRIP DESTINATION UNDERSERVED AREA YES NO W. Lawrence Ave N. Harlem Ave. X S. State St W. Addison EXAMPLE X Total Yes Total No Page

9 CITY OF CHICAGO DEPARTMENT OF REVENUE APPLICATION FOR PARTICIPATION IN THE UNDERSERVED AREAS CREDIT PROGRAM Pursuant to Public Passenger Vehicle License Holder Rule no registered with the Department of Revenue under account, hereby applies for participation in the Ground Transportation Tax Credit Program for Operating in Underserved Areas. The medallion number of the taxicabs and license plate number of the livery vehicles that will operate in underserved areas, for which credit will be taken, are as follows (attach an additional sheet if necessary): Medallion or Plate Number Operated by: (Applicant or Lessee) As a condition of participation in the program, the applicant hereby certifies that the applicant and any lessee of the above referenced vehicles, will agree to prepare and maintain daily trip sheets as described in section 23.4 E of the rule, on a form prescribed by the Department of Revenue, for each vehicle for which a credit is claimed. Signature of Authorized Representative or Applicant Date of Application M M D D Y Y Y Y Signature of Department of Revenue Representative Date of Receipt M M D D Y Y Y Y To be completed by the Department of Revenue Resolution: Approved Denied Date of Resolution: M M D D Y Y Y Y Month/Year in which credit may first be taken: M M Y Y Y Y Explanation of Denial Page

10 Chicago Department of Revenue Annualization Schedule ACCOUNT NUMBER TAX CODE BEGINNING PERIOD ENDING PERIOD Note: Please fill out this form if you meet at least one of the following criteria. 1. You paid or remitted at least $2 million dollars for any given tax type for the preceding annual tax year. 2. Your actual liability for this Annual Return Tax during any three consecutive calendar months of the twelve month period immediately preceding the current Annual Tax Year was greater than 50 percent of your liability for such Annual Return Tax for such entire twelve month period. 3. You are a new business that began after July 1st of the current tax year (an incomplete tax year). 4. You voluntarily elect to pay on an actual basis. 5. You did not remit one or more payment coupons or did not file a return in the twelve-month period immediately preceding the tax year now being filed. Tax Computed Due NOTE: DO NOT ENTER GROSS CHARGE/RECEIPT AMOUNTS. (Before any applicable commission) 1. July August September October November December January February March April May June... Total Tax Computed Due Before Any Applicable Commission. This amount must equal the tax due before commission reported on the tax return. Any difference will be applied to the earliest payment period. Page 1 V