STAMP HERE
1 Olde Half Day Road, Lincolnshire, IL 60069 www.lincolnshireil.gov P: 847-883-8600 F: 847-883-8608
FOOD AND BEVERAGE TAX REGISTRATION FORM
Name of Business (DBA):
Please review the attached Food & Beverage Tax Ordinance before continuing:
1. Is your business responsible for payment of the Food and Beverage Tax? Yes No
• If Question 1 is answered “No”, please complete Question 2, sign the registration and
return to the address above.
• If Question 1 is answered “Yes”, skip Question 2, complete remainder of registration,
sign and return registration to the address above.
2. Please list reason(s) why you believe your business is not liable for collection and payment of
the Food & Beverage Tax below (if you require additional room, please detail on an attached
page):
___________________________________________________________________________
___________________________________________________________________________
Business Phone Number:
Business Email Address:
Business Location (Street Address, City, State, Zip):
Business Mailing Address (if different from Business Location):
Date Business Opens:
Nature of Business (i.e. restaurant, deli, etc.)
Check all that apply: Liquor (consumed
on premises)
Packaged
Liquor
Food & non-
alcoholic drinks
Catering
Name of Owner Manager
Owner/Manager Phone Number Owner/Manager Email Address:
Name of Tax Return Preparer
Preparer’s Phone Number Preparer’s Email Address
IL Sales Tax # (aka Illinois Retailer Occupation Tax Number or IBT):
Federal Tax ID #
Frequency of filing with Illinois Dept of Revenue: Monthly Quarterly Semi-annually Annually
Under penalties as provided by law, I declare that to the best of my knowledge and belief, the information
on this form is true, correct and complete.
___________________________ ______________________________________ ____________
Signature Printed Name & Title Date
click to sign
signature
click to edit
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