Form 962 Form Mc-2 - Medical Cannabis Sales - Illinois

Form 962 or the "Form Mc-2 - Medical Cannabis Sales" is a form issued by the Illinois Department of Revenue.

Download a PDF version of the Form 962 down below or find it on the Illinois Department of Revenue Forms website.

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Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
REV 01
FORM 962
MC-2
Medical Cannabis Sales
Page _____ of _____
Attach Schedule MC-2 to Form MC-1, Medical Cannabis Cultivation Privilege Tax Return.
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
License no.: MC - ___ ___ ___ ___ ___
Reporting period: ___ ___ / ___ ___ ___ ___
Month
Year
See Specific Instructions before completing the information below.
Cultivation center’s information
Location code of selling cultivation center
___ ___ ___ - ___ ___ ___ ___ - ___ - ___ ___ ___
Dispensing organization’s information
Account ID
___ ___ ___ ___ - ___ ___ ___ ___
Registry ID number ___ ___ - ___ ___ ___
Business name
_____________________________________________________________________________________
Physical address
_____________________________________________________________________________________
Number and street
City
State
ZIP
Figure your privilege tax base
Ounces sold to this dispensing organization
1a
1a _____________________
Number of bulk ounces
2a
2a _____________________
Number of ounces infused into products
Consideration received from this dispensing organization
4a
4a _____________________
Consideration received for bulk ounces
5a
5a _____________________
Consideration received for ounces infused into products
Cultivation center’s information
Location code of selling cultivation center
___ ___ ___ - ___ ___ ___ ___ - ___ - ___ ___ ___
Dispensing organization’s information
Account ID
___ ___ ___ ___ - ___ ___ ___ ___
Registry ID number ___ ___ - ___ ___ ___
Business name
_____________________________________________________________________________________
Physical address
_____________________________________________________________________________________
Number and street
City
State
ZIP
Figure your privilege tax base
Ounces sold to this dispensing organization
1a
1a _____________________
Number of bulk ounces
2a
2a _____________________
Number of ounces infused into products
Consideration received from this dispensing organization
4a
4a _____________________
Consideration received for bulk ounces
5a
5a _____________________
Consideration received for ounces infused into products
Page totals
1a _____________________
2a _____________________
4a _____________________
5a _____________________
496201110
Reset
Print
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
MC-2 (N-05/15)
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
REV 01
FORM 962
MC-2
Medical Cannabis Sales
Page _____ of _____
Attach Schedule MC-2 to Form MC-1, Medical Cannabis Cultivation Privilege Tax Return.
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
License no.: MC - ___ ___ ___ ___ ___
Reporting period: ___ ___ / ___ ___ ___ ___
Month
Year
See Specific Instructions before completing the information below.
Cultivation center’s information
Location code of selling cultivation center
___ ___ ___ - ___ ___ ___ ___ - ___ - ___ ___ ___
Dispensing organization’s information
Account ID
___ ___ ___ ___ - ___ ___ ___ ___
Registry ID number ___ ___ - ___ ___ ___
Business name
_____________________________________________________________________________________
Physical address
_____________________________________________________________________________________
Number and street
City
State
ZIP
Figure your privilege tax base
Ounces sold to this dispensing organization
1a
1a _____________________
Number of bulk ounces
2a
2a _____________________
Number of ounces infused into products
Consideration received from this dispensing organization
4a
4a _____________________
Consideration received for bulk ounces
5a
5a _____________________
Consideration received for ounces infused into products
Cultivation center’s information
Location code of selling cultivation center
___ ___ ___ - ___ ___ ___ ___ - ___ - ___ ___ ___
Dispensing organization’s information
Account ID
___ ___ ___ ___ - ___ ___ ___ ___
Registry ID number ___ ___ - ___ ___ ___
Business name
_____________________________________________________________________________________
Physical address
_____________________________________________________________________________________
Number and street
City
State
ZIP
Figure your privilege tax base
Ounces sold to this dispensing organization
1a
1a _____________________
Number of bulk ounces
2a
2a _____________________
Number of ounces infused into products
Consideration received from this dispensing organization
4a
4a _____________________
Consideration received for bulk ounces
5a
5a _____________________
Consideration received for ounces infused into products
Page totals
1a _____________________
2a _____________________
4a _____________________
5a _____________________
496201110
Reset
Print
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
MC-2 (N-05/15)

Download Form 962 Form Mc-2 - Medical Cannabis Sales - Illinois

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