Form Rmft-5-X - Amended Return/claim For Credit - Motor Fuel Tax For Distributor/suppliers - 2011
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Illinois Department of Revenue
RMFT-5-X
Amended Return/Claim for Credit
Motor Fuel Tax for Distributor/Suppliers
Sequence no. ______
Station no. 564
Step 1: Identify yourself
Do not write above this line.
Name_________________________________________________
Original reporting period ___________/__ __ __ __
Month
Year
D
-
S
-
Address_______________________________________________
Distributor license no.
OR Supplier license no.
Number and street
______________________________________________________
Telephone no. (__ __ __) __ __ __ - __ __ __ __
City
State
ZIP
As originally reported or adjusted
Corrected amounts
Note: You must report your motor fuel in gallons. Convert liters to gallons
by multiplying liters by .2641721. Follow our instructions for each column.
Column 1
Column 2
Column 3
Column 1
Column 2
Column 3
Step 2: Figure your total gallonage for the month
Gasoline &
Special fuel except
Gasoline &
Special fuel except
combustible gases
dyed diesel fuel
Dyed diesel fuel
combustible gases
dyed diesel fuel
Dyed diesel fuel
1 Write your actual (stick) inventory at the beginning of the month. This
1
amount must agree with closing inventory of preceding month’s return.
2 Write the number of gallons
a produced, acquired, received or transported into Illinois tax-free
2a
(Schedule A, SA, or DA)
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b produced, acquired, received or transported into Illinois tax-paid
2b
(Schedule E or SE)
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c of combustible gases/1-K kerosene/alcohol sold for highway use
2c
(Schedule GA-1)
3 Add Lines 1 through 2c. Remember to do calculations within each column.
3
4 Write your actual (stick) inventory at the end of the month.
4
5 Subtract Line 4 from Line 3. This is your net gallonage for the month.
5
Step 3: Figure your nontaxable gallonage
6 Write the number of gallons sold to the federal government,etc.
6
(Schedule B, SB, or DB)
7 Write the number of gallons exported from Illinois
7
(Schedule C, SC, or DC)
8 Write the number of gallons
a sold and distributed tax-free to a distributor or supplier
8a
(Schedule D, SD, or DD)
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b sold and distributed tax-free to other than a distributor or supplier
8b
(Schedule DD-1)
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c of dyed diesel fuel you used for nonhighway purposes
8c
9 Write the number of gallons lost due to fire, leakage, spillage, etc.
9
(Schedule F)
10 Write the number of gallons of your loss due to temperature variation or evaporation
or your gain due to temperature variation. Complete Line 10a or 10b per column.
a Loss. The amount of losses you claim are limited. See instructions.
10a
or
(
) (
) (
)
(
) (
) (
)
b Gain.
10b
11 Add Lines 6 through 10b. This amount is your total nontaxable gallonage.
11
12 Subtract Line 11 from Line 5. The amount in Column 3 should be zero.
12
Steps 4 & 5: Figure your taxable gallonage
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13 Write the number of gallons sold and distributed for taxable purposes.
13
14 Write the number of gallons you used in motor vehicles on public highways
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or for operating recreational-type watercraft on waters of Illinois.
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15 Write the number of gallons you used for nontaxable (nonhighway) purposes.
15
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16 Add Lines 13, 14, and 15. This is your gross taxable gallonage.
16
17 Write the number of gallons on which tax was paid at the time of purchase.
17
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(Schedule E or SE)
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18 Subtract Line 17 from Line 16. This is your net taxable gallonage.
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RMFT-5-X front (R-05/11)
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