Form PT-13 Members Selling Pull Tabs - Illinois

Form PT-13 is a Illinois Department of Revenue form also known as the "Members Selling Pull Tabs". The latest edition of the form was released in August 1, 2015 and is available for digital filing.

Download a PDF version of the Form PT-13 down below or find it on Illinois Department of Revenue Forms website.

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Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue
PT-13
Members Selling Pull Tabs
Read this information first
When applying for a pull tabs license, you must complete Form PT-13. 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.
Note: If, at a later date, you need to revise any information you included on this form, complete a new PT-13.
If you have questions, visit our website at tax.illinois.gov or call us at 217 785-5864.
Complete the following information
What is your pull tab license number?_________________
List below the members or employees of your organization who will be selling Pull Tabs. These members must be bona fide
members who have belonged to your organization for at least thirty days, or employees of your licensed organization. You may
attach additional sheets if necessary.
Name
Address
1 _______________________________________
_____________________________________________________________
2 _______________________________________
_____________________________________________________________
3 _______________________________________
_____________________________________________________________
4 _______________________________________
_____________________________________________________________
5 _______________________________________
_____________________________________________________________
6 _______________________________________
_____________________________________________________________
7 _______________________________________
_____________________________________________________________
8 _______________________________________
_____________________________________________________________
9 _______________________________________
_____________________________________________________________
10______________________________________
_____________________________________________________________
11______________________________________
_____________________________________________________________
12______________________________________
_____________________________________________________________
13______________________________________
_____________________________________________________________
14______________________________________
_____________________________________________________________
15______________________________________
_____________________________________________________________
Sign below
I hereby certify that the sellers listed above are bona fide members or employees of the licensed organization. I further certify that
the licensed organization has a complete and current membership list available for inspection by the Illinois Department of
Revenue during reasonable business hours.
_____________________________________________________
______________________________________
Signature of presiding officer
Date
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.
PT-13 (R-08/15)
Reset
Print
Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue
PT-13
Members Selling Pull Tabs
Read this information first
When applying for a pull tabs license, you must complete Form PT-13. 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.
Note: If, at a later date, you need to revise any information you included on this form, complete a new PT-13.
If you have questions, visit our website at tax.illinois.gov or call us at 217 785-5864.
Complete the following information
What is your pull tab license number?_________________
List below the members or employees of your organization who will be selling Pull Tabs. These members must be bona fide
members who have belonged to your organization for at least thirty days, or employees of your licensed organization. You may
attach additional sheets if necessary.
Name
Address
1 _______________________________________
_____________________________________________________________
2 _______________________________________
_____________________________________________________________
3 _______________________________________
_____________________________________________________________
4 _______________________________________
_____________________________________________________________
5 _______________________________________
_____________________________________________________________
6 _______________________________________
_____________________________________________________________
7 _______________________________________
_____________________________________________________________
8 _______________________________________
_____________________________________________________________
9 _______________________________________
_____________________________________________________________
10______________________________________
_____________________________________________________________
11______________________________________
_____________________________________________________________
12______________________________________
_____________________________________________________________
13______________________________________
_____________________________________________________________
14______________________________________
_____________________________________________________________
15______________________________________
_____________________________________________________________
Sign below
I hereby certify that the sellers listed above are bona fide members or employees of the licensed organization. I further certify that
the licensed organization has a complete and current membership list available for inspection by the Illinois Department of
Revenue during reasonable business hours.
_____________________________________________________
______________________________________
Signature of presiding officer
Date
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.
PT-13 (R-08/15)
Reset
Print

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