STATUS [ ] For office use only

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Augustine Sutton
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1 CITY OF CHICAGO DEPARTMENT OF REVENUE USE TAX RETURN FOR TITLED PERSONAL PROPERTY 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). You are filing as (mark one): A Business An Individual See Attachment for Section 1. Section Purchase price (see instructions) Deductions (see line 2c of instructions) Amount subject to tax (subtract line 2 from line 1) Tax Rate % 5. Tax Due (multiply line 3 by line 4) STOP AT LINE 5 IF THIS IS AN AMENDED RETURN Current year's tax payments Total tax due (subtract line 6 from line 5). if line 7 is greater than 0, enter the amount owed. If line 7 is less than 0 please skip to line Interest for late payment (line 18c) of instructions Penalty for late payment/filing (see instructions)

2 REVISION NUMBER 10. Total tax, interest, and penalty (add lines 7, 8, and 9) Overpayment. If line 7 is less than 0, enter amount of overpayment If you want the amount of the overpayment to be credited to next year's estimated tax, enter a check in 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. 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 2 V

3 INSTRUCTIONS FOR PREPARING THE USE TAX RETURN 8400 FOR TITLED PERSONAL PROPERTY The description of the vehicle purchased outside Chicago and titled to an address inside Chicago was obtained from the State of Illinois Secretary of State database. The automobile dealer collected only State and local taxes and did not collect the City of Chicago Use Tax. Currently, you are required to compute and pay this tax directly to the Chicago Department of Revenue. LINE 1. LINE 2. a. Purchase price (including all accessories, state sales / use tax, and other local taxes paid.)... Deductions: Trade-in allowance (if applicable; do not include down payment)... b. State and other local taxes actually paid to an out of Chicago retailer (if included in line 1)... c. Total deductions (add 2a and 2b)... LINE 3. Net amount subject to tax (subtract line 2c from line 1)... LINE 4. LINE 5. LINE 6. LINE 7. LINE 8. 8a. Preprinted tax rate. Tax due before current year's tax payments (multiply line 3 by line 4). Current year's tax payments. Total tax due (subtract line 6 from line 5). If line 7 is greater than 0, enter the amount owed. If line 7 is less than 0, skip to line 11. Determine the amount of interest owed based on tax past due. Enter number of days late... 8b. Enter amount from line c. Total amount of interest (8b * [8a / 365]) * 12%... LINE 9. 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% = $ 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 7. b) If the return is filed late, compute the greater of 1) 1% of line 5 (up to a maximum of $5,000) or 5% of line 7. 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. LINE 10. Total tax, interest, and penalty (add lines 7, 8, and 9). LINE 11. Overpayment. If line 7 is less than 0, enter amount of overpayment. LINE 12. If you want the amount of the overpayment to be credited to next year's estimated tax, enter a check in 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

4 SECTION 1 ATTACHMENT USE TAX RETURN 8400 FOR TITLED PERSONAL PROPERTY If you purchased more vehicles, copy this page to list all cars

5 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. V

STATUS [ ] For office use only

CITY OF CHICAGO DEPARTMENT OF REVENUE HOTEL ACCOMMODATIONS TAX - 7520 STATUS [ ] For office use only ACCOUNT NUMBER DUE DATE CHECK IF RETURN IS: Mail Payment and Return to: Amended BEGINNING PERIOD ENDING