CITY OF CHICAGO DEPARTMENT OF REVENUE
GROUND TRANSPORTATION TAX - 7595US STATUS [ ]
For office use only
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7595201105
Current year's tax payments...
STOP AT LINE 7 IF THIS IS AN AMENDED RETURN
Note: List all medallion numbers if you have less than five taxicabs:
1. 2. 3. 4.
Tax due before underserved credits and current year's payments
(add lines 1 - 4)...
FOR USE BY APPROVED APPLICANTS OF UNDERSERVED AREAS CREDIT PROGRAM ONLY
Underserved area credit (see instructions) ...
Tax due before current year's payments (subtract line 6 from line 5) ...
Taxicabs (line 1b of instructions)
Taxable Days Tax Rate Tax Due
10 or fewer passengers (line 2d of instructions)...
11 to 24 passengers (line 3d of instructions)...
25 or more passengers (line 4d of instructions)...
1.
2.
3.
4.
5.
6.
7.
8.
Page 1
DUE DATE Mail Payment and Return to:
BUSINESS PHONE:
BEGINNING PERIOD
BUSINESS ADDRESS:
CHECK IF RETURN IS:
ENDING PERIOD
MAILING ADDRESS:
Check the following if deposits were:
(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 ofRevenue at (312) 747-IRIS (4747). Do not fill in cents amount, round up to nearest dollar (if 50 cents or more).
Estimate Actual
ACCOUNT NUMBER
Amended
Number of Sites:
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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.
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.
11.
12.
13.
14.
ACCOUNT NUMBER REVISION NUMBER
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 13...
Interest for late payment (line 10c of instructions)...
9.
10.
Credit Refund
0 0
0 0
0 0
0 0
0 0
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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.
Page 3
ACCOUNT NUMBER REVISION NUMBER
For DOR Use Only Postmark Date Receipt Number 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
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
TITLE
SIGNATURE (REQUIRED)
DATE
• 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.
MARKING INSTRUCTIONS
MARKING INSTRUCTIONS
INSTRUCTIONS FOR PREPARING THE
GROUND TRANSPORTATION TAX RETURN - 7595US
ACCOUNT NUMBER
LINE 2. 10 or fewer passenger capacity vehicles LINE 1. Taxicabs
Enter the total number of taxicabs that were used in Chicago during the entire tax year...
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 + 100 days + 50 days + 100 days).
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 3-46-060 of this ordinance...
Enter the total number of vehicles that were used in Chicago during the entire tax year...
Enter the total number of days each vehicle in line 2a was used in Chicago...
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 + 100 days + 50 days + 100 days).
LINE 4. 25 or more passenger capacity vehicles
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 3-46-060 of this ordinance...
Enter the total number of vehicles that were used in Chicago during the entire tax year...
Enter the total number of days each vehicle in line 4a was used in Chicago...
Taxable days (subtract line 4c from line 4b)...
Note: Maximum use per vehicle could be 365 days LINE 3. 11 to 24 passenger capacity vehicles
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 3-46-060 of this ordinance...
Enter the total number of vehicles that were used in Chicago during the entire tax year...
Enter the total number of days each vehicle in line 3a was used in Chicago...
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 + 100 days + 50 days + 100 days).
a.
b.
b.
a.
c.
d.
b.
a.
c.
d.
b.
a.
c.
d.
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NOTE: YOU MUST COMPLETE ALL INFORMATION ON THIS PAGE FOR THIS RETURN TO BE CONSIDERED COMPLETE.
FOR ADDITIONAL INFORMATION CALL 312-747-IRIS (4747) (TTY 312-742-1974) 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.
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.
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.
Determine the amount of interest owed based on tax past due.
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.
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).
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.
LINE 13.
LINE 14.
LINE 12.
LINE 11.
LINE 10.
LINE 9.
LINE 8.
LINE 7.
Enter number of days late (August 16 being one day late, etc.). ...
Enter amount from line 9. ...
Total amount of interest (10b * [10a / 365]) * 12%...
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)...
Enter total # of trips for the entire tax year (from your entire tax yearly worksheet)...
Divide line a by line b...
Multiply line c by the tax calculated on line 5...
Enter 50 percent of the tax due calculated on line 5...
Enter the lesser of line d or e--this is your underserved area tax credit...
a.
b.
c.
d.
e.
f.
LINE 6.
Tax due before underserved credits and current year's payments (add lines 1 through 4)...
LINE 5.
10a.
10b.
10c.
ACCOUNT NUMBER REVISION NUMBER
0 0
0 0 0 0
0 0
0 0
0 0
0 0
GROUND TRANSPORTATION VEHICLE WORKSHEET
INSTRUCTIONS: COMPLETE ONE WORKSHEET FOR EACH GROUND TRANSPORTATION VEHICLE
EXAMPLE 1
2 02
BUSINESS PHONE
FIRST NAME LAST NAME
BUSINESS NAME
BUSINESS ADDRESS
CITY STATE ZIP LICENSE HOLDER NAME
LICENSE PLATE NUMBER MEDALLION NUMBER ACCOUNT NUMBER
CHECK VEHICLE INFO: OWN LEASE
CHECK MONTH: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Date Start Odometer
Reading
End Odomoter
Reading Out-of-Service Code (See Below) # of Trips in Underserved Area
Total Trips for Entire Day*
In Service?
Yes No
3
4
5
6
7
8
9
10
11
12
15
16 14 13
17
18 1
2
5 4 5 7 6 5 4 2 6 0
X X
GROUND TRANSPORTATION VEHICLE WORKSHEET
INSTRUCTIONS: COMPLETE ONE WORKSHEET FOR EACH GROUND TRANSPORTATION VEHICLE
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Date Start Odometer
Reading
End Odomoter
Reading Out-of-Service Code (See Below) # of Trips in Underserved Area
Total Trips for Entire Day*
In Service?
Yes No
Page 2
* 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.
7595204205
TOTAL DAYS:
In Service Out-of- Service TRIP TOTALS
Underserved
Areas Grand Total (To be forwarded to 7595US tax return) 23
24
25
26
27
28
29
30
31 21
22
0UT-OF-SERVICE CODES
01 = REPAIR02 = DID NOT WORK 03 = OTHER (DESCRIBE) Retain documentation to substantiate the reasons your vehicle was out of service for a particular day (i.e., repair bill, accident report, etc.).
FIRST NAME LAST NAME
Taxpayer Statement
Under the penalty of perjury, I certify that the information provided above is true, correct, and complete.
SIGNATURE (REQUIRED) TITLE
ORIGIN/DESTINATION LOG SHEET
DATE TRIP ORIGIN TRIP DESTINATION
UNDERSERVED AREA
YES NO
5600 W. Lawrence Ave. 6200 N. Harlem Ave. X
EXAMPLE
333 S. State St. 1060 W. Addison X
ACCOUNT NUMBER
0 6 2 1 9 9
0 6 2 1 9 9
CITY OF CHICAGO DEPARTMENT OF REVENUE
APPLICATION FOR PARTICIPATION
IN THE UNDERSERVED AREAS CREDIT PROGRAM
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Pursuant to Public Passenger Vehicle License Holder Rule no. 23.4
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.
Date of Application Signature of Authorized Representative or Applicant
Date of Receipt Signature of Department of Revenue Representative
To be completed by the Department of Revenue
Resolution: Approved Denied
Date of Resolution:
Month/Year in which credit may first be taken:
Explanation of Denial
7595206105 M M D D Y Y Y Y
M M D D Y Y Y Y
M M D D Y Y Y Y
M M Y Y Y Y
Page 1
Chicago Department of Revenue
Annualization Schedule
ACCOUNT NUMBER TAX CODE
You voluntarily elect to pay on an actual basis.
July ...
March ...
May ...
April ...
February ...
January ...
December ...
November ...
October ...
September ...
August ...
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ENDING PERIOD BEGINNING PERIOD
Note: Please fill out this form if you meet at least one of the following criteria.
12. June ...
Total Tax Computed Due Before Any Applicable Commission.
You paid or remitted at least $2 million dollars for any given tax type for the preceding annual tax year.
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.
You are a new business that began after July 1st of the current tax year (an incomplete tax year).
1.
2.
3.
4.
Tax Computed Due
(Before any applicable commission)