Form Rmft-11-A - Illinois Motor Fuel Tax Refund Claim Page 4
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4Step 8: Itemize your equipment
34
Complete the following list of equipment in detail. Use extra sheets if necessary.
EQUIPMENT USED
DESCRIPTION
MOTOR FUEL TYPE
GALLONS USED
Check
appropriate column
Check
appropriate column
Undyed
Auto
Truck
Tractor
Misc. Print the make, model, year, and horsepower
diesel
Gasoline
LPG
Tax paid
Step 9: Sign below
Under penalties of perjury, I state that I have examined this refund claim and, to the best of my knowledge, it is true, correct,
and complete.
_______________________________________________________________________________________________
_____________________________
Signature
Title
Date
Step 10: Mail your refund claim
Mail your refund claim to:
MOTOR FUEL TAX REFUND SECTION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
Reminders:
Please send us the original refund claim, plus one copy. Keep a copy for your records.
Purchase documentation must be submitted when requested.
RMFT-11-A Page 4 of 4 (R-8/05)
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