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Fill a Valid Illinois Reg 10 Form

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The Illinois REG-10 form serves as a crucial tool for individuals and businesses purchasing natural gas from outside the state for use within Illinois. Designed for those who are not exempt from the Gas Use Tax, this application allows purchasers to register as self-assessors, enabling them to report and pay the Gas Use Tax directly to the Illinois Department of Revenue rather than through their suppliers. Upon successful submission and processing of the REG-10 form, applicants receive a certificate of registration, which acts as proof of their responsibility for tax reporting and payment. It's important to note that businesses already registered for Gas Revenue Tax do not need to complete this application. Additionally, if a purchaser's circumstances change, they must fill out a new REG-10 form. This form also outlines specific exemptions, such as those for businesses in enterprise zones or governmental entities, emphasizing the importance of understanding eligibility before proceeding. Regular updates to the form every five years help maintain accurate records, ensuring compliance with state tax regulations.

Example - Illinois Reg 10 Form

Illinois Department of Revenue

REG-10 GasUseTax

Self-Assessing Purchaser Application

Step 1: Read this information first

Station 265

If you purchase natural gas from outside of Illinois for use in Illinois (not for resale) you may choose to become a self-assessor of Gas Use Tax unless you are exempt from Gas Use Tax(See below.). A registered self-assessing purchasermust report and pay the Gas Use Tax directly to us rather than to their supplier. After we process your completed Form REG-10, we will issue you a certificate of registration for you to provide to your supplier. Your certificate of registration is proof that you will be responsible for reporting and paying of the Gas Use Tax. If later, any information you provide below should change, you must complete a new Form REG-10. If no changes are needed, you should submit a new Form REG-10 every five years to keep records current. If you have any questions, call us weekdays between 8:00 a.m. and 4:30 p.m. at 217 524-5406 or 217 785-6602.

To be exempt, you must purchase natural gas from outside of Illinois that will be used in Illinois

•by a business located in an enterprise zone;

•by a governmental body or entity organized and operated exclusively for charitable religious, or educational purposes;

•in the production of electric energy;

•in a petroleum refinery operation;

•in liquefaction and fractionation processes that produce value added natural gas by-products for resale; or

•in the production of anhydrous ammonia and nitrogen fertilizer for resale.

Do not completeFormREG-10ifyouareexemptfromGasUseTax.YoumustcompleteFormRG-61,GasUseTaxExemption Certificate.

Step 2: Identify yourself - Individuals only

1

Name:______________________________________________

3

Address:____________________________________________

2

Social Security number: ___ ___ ___ - ___ ___ -___ ___ ___ ___

 

___________________________________________________

 

 

 

 

 

City

State

ZIP

 

 

 

 

 

_____________________

(_____)_____-______________

 

 

 

 

 

County

Telephone number

 

 

 

 

Step3: Identify your business - Businesses only

 

 

Note: If you are already registered for Gas Revenue Tax,you do not need to complete this application:

 

4

Name:______________________________________________

7

IllinoisBusinessTaxno.:

___ ___ ___ ___ - ___ ___ ___ ___

5

Corporate name:______________________________________

8

FederalEmployerIdentificationno.: __ __-__ __ __ __ __ __ __

6

Address: ____________________________________________

 

 

 

 

 

Number and street

 

 

 

 

 

 

 

___________________________________________________

 

 

 

 

 

City

State

ZIP

 

 

 

 

 

_____________________

(_____)_____-______________

 

 

 

 

 

County

Telephone number

 

 

 

 

 

Step 4: Identify your delivering supplier(s)

If you need to identify more than provided for, attach additional sheet(s).

9 ___________________________________________________

___________________________________________________

Name

Name

___________________________________________________

___________________________________________________

Name

Name

___________________________________________________

___________________________________________________

Name

Name

Step 5: Complete and sign below

Check here to acknowledge that no exemption listedin Step 1 applies to you or your business or organization.

Underpenaltiesofperjury,IstatethatIhaveexaminedthisapplicationand,tothebestofmyknowledge,itistrue,correct,andcomplete.

_______________________________________________________

______________________________________________________

Signature

Date

Typed or printed name of person signing to the left

Mail your completed Form REG-10 to

 

 

REGISTRATION AND RETURNS PROCESSING

 

If you have any questions, call our Springfield office weekdays

ILLINOISDEPARTMENTOFREVENUE

 

between 8:00 a.m. and 4:30 p.m. at 217 524-5406 or 217 785-6602.

POBOX19019

 

 

SPRINGFIELD IL 62794-9019

 

 

REG-10(N-05/03)

ThisformisauthorizedbytheGasRevenueTax andGasUseTaxActs.DisclosureofthisinformationisREQUIRED.Failureto provide information could result in a penalty. Thisform has been approved by the Forms Management Center. IL-492-4354

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Document Breakdown

Fact Name Description
Purpose The REG-10 form is used by individuals and businesses in Illinois to apply for self-assessment of the Gas Use Tax when purchasing natural gas from outside the state.
Eligibility To use this form, the purchaser must not be exempt from the Gas Use Tax and must intend to use the gas in Illinois, not for resale.
Exemption Criteria Exemptions apply if the gas is used by certain entities, including businesses in enterprise zones, governmental bodies, or for specific production processes.
Submission Frequency Once registered, the self-assessing purchaser must submit the REG-10 form every five years to maintain current records.
Governing Laws This form is authorized by the Gas Revenue Tax and Gas Use Tax Acts, which govern the reporting and payment of the Gas Use Tax in Illinois.
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