Schedule Se - Mft, Ust, And Eif Tax- And Fee-Paid Purchases Of Special Fuel (Excluding Dyed Diesel Fuel)
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1
2MFT, UST, and EIF
Illinois Department of Revenue
Page ____ of ____
Schedule SE
Tax- and Fee-Paid Purchases of
Special Fuel (Excluding Dyed Diesel Fuel)
Attach to Form RMFT-5 or Form RMFT-5-US
Step 1: Complete the following information
_______________________________________________
Check the tax/fee type you are listing on this page.
Check the product type you are listing on this page.
Company name
Special fuel (excluding dyed diesel fuel)
MFT-paid only
_______________________________________________
Your license number
UST-/EIF-paid only
1-K kerosene
Other (specify:_________________________)
Reporting period __ __/__ __ __ __
Both MFT- and UST-/EIF-paid
Month
Year
Step 2: Report your tax- and fee-paid purchases
1
2
3
4
5
6
7
8
9
Invoice date
Invoice
Name of
Bill of lading or
Origin
Destination
Seller’s
Invoiced
number
carrier
manifest number
Name of seller
(Illinois cities only)
(Illinois cities only)
license number
gallons
(month, day, year)
1
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
2
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
3
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
4
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
5
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
6
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
7
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
8
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
9
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
10
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here.
11
________________
12 If you are filing only one Schedule SE, write the amount from Line 11 here.
12
________________
If you are reporting special fuel or other product type
• MFT-paid gallons only, also write this amount on Form RMFT-5, Lines 2b and 17, Column 2.
• UST-/EIF-paid gallons only, also write this amount on Form RMFT-5-US, Lines 2b and 12, Column 1.
• both MFT- and UST-/EIF-paid gallons, also write this amount on Form RMFT-5, Lines 2b and 17, Column 2, and Form RMFT-5-US, Lines 2b and 12, Column 1.
If you are reporting 1-K product type, write this amount on Form RMFT-5, Line 17, Column 2.
If you are filing more than one Schedule SE, see instructions.
RMFT-10-SF front (R-3/01)
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