Instructions for Form Pt-12 - Expenditures of Pull Tab Funds

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Form PT-12 Instructions
General Information
If you are licensed to sell pull tabs in Illinois, you must complete Form PT-12. It must be completed annually when you renew
your license. You no longer have to submit the form to us. Keep the completed copy in your records and make it available to us
when we request it. You must maintain all records for a period of three years.
If you have questions, visit our website at tax.illinois.gov or call us at 217 785-5864.
Step-by-Step Instructions
Step 1: Identify yourself
Enter the information requested on the lines provided. The period covered must begin with last year’s ending date and should
end with the last completed quarter prior to the expiration date of your license. If this is your first report, enter the date your
license was issued.
Step 2: Figure your pull tab proceeds
Line 1 - Enter the total receipts from the sale of pull tabs. (This is the amount upon which the 5 percent pull tab tax is based).
Line 2 - Enter the amount of cash prizes awarded from pull tab sales.
Line 3 - Subtract Line 2 from Line 1. The entire net proceeds must be deposited in your pull tab checking account.
Line 4 - Enter the total amount, other than pull tab proceeds, deposited into your pull tab checking account. Also include any
interest earned on the account and any deposits from other sources.
Line 5 - Enter the balance in your pull tab checking account at start of reporting period. If this is your first report, you will enter zero.
Note: This figure should correspond with the ending balance figure from your prior year expenditure report.
Line 6 - Add Lines 3, 4, and 5.
Line 7 - Enter on Line 7 the sum of all checks written. This amount includes the cost of printing checks and any other charges
to the account.
Line 8 - Subtract Line 7 from Line 6.
Line 9 - Line 9 should equal Line 8. If the amounts are not identical, please explain the discrepancy here.
Step 3: List your checks and charges in sequential order
Provide a complete listing of all checks and charges for this account for the reporting period.
Step 4: Provide your financial institution information
Enter the information requested on the line provided.
PT-12 instructions (R-08/15)
Form PT-12 Instructions
General Information
If you are licensed to sell pull tabs in Illinois, you must complete Form PT-12. It must be completed annually when you renew
your license. You no longer have to submit the form to us. Keep the completed copy in your records and make it available to us
when we request it. You must maintain all records for a period of three years.
If you have questions, visit our website at tax.illinois.gov or call us at 217 785-5864.
Step-by-Step Instructions
Step 1: Identify yourself
Enter the information requested on the lines provided. The period covered must begin with last year’s ending date and should
end with the last completed quarter prior to the expiration date of your license. If this is your first report, enter the date your
license was issued.
Step 2: Figure your pull tab proceeds
Line 1 - Enter the total receipts from the sale of pull tabs. (This is the amount upon which the 5 percent pull tab tax is based).
Line 2 - Enter the amount of cash prizes awarded from pull tab sales.
Line 3 - Subtract Line 2 from Line 1. The entire net proceeds must be deposited in your pull tab checking account.
Line 4 - Enter the total amount, other than pull tab proceeds, deposited into your pull tab checking account. Also include any
interest earned on the account and any deposits from other sources.
Line 5 - Enter the balance in your pull tab checking account at start of reporting period. If this is your first report, you will enter zero.
Note: This figure should correspond with the ending balance figure from your prior year expenditure report.
Line 6 - Add Lines 3, 4, and 5.
Line 7 - Enter on Line 7 the sum of all checks written. This amount includes the cost of printing checks and any other charges
to the account.
Line 8 - Subtract Line 7 from Line 6.
Line 9 - Line 9 should equal Line 8. If the amounts are not identical, please explain the discrepancy here.
Step 3: List your checks and charges in sequential order
Provide a complete listing of all checks and charges for this account for the reporting period.
Step 4: Provide your financial institution information
Enter the information requested on the line provided.
PT-12 instructions (R-08/15)

Download Instructions for Form Pt-12 - Expenditures of Pull Tab Funds

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