Form Rmft-11 - Illinois Motor Fuel Tax Refund Claim - 2000
ADVERTISEMENT
1
2
3
4Illinois Department of Revenue
RMFT-11
Illinois Motor Fuel Tax Refund Claim
Important note: Only use this version of the Form RMFT-11, which has the revision date of January 2000 (R-1/2000), to
file a refund claim for the motor fuel you used for nonhighway purposes on or after January 1, 2000.
Step 1: Identify the period covered by this claim
1
Identify claim period beginning on or after January 1, 2000. From:__ __ /__ __ __ __
To:__ __ /__ __ __ __
Month/Year
Month/Year
2
Tell us when you filed your last claim __ __ /__ __ __ __
Month/Year
Step 2: Identify yourself
_____________________________
3
4
FEIN: __ __ - __ __ __ __ __ __ __
or
Name
_____________________________
SSN: __ __ __ - __ __ -__ __ __ __
Address
_____________________________
5
Phone no.: (______) ______ - ________
City, state, ZIP
6
If you are currently licensed as an Illinois distributor or supplier, write your motor fuel license number.
__ - __ __ __ __ __
Step 3: Figure your refund
Complete the columns below to list your tax-paid motor fuel gallons. Your refund claim must be based on the motor fuel you
actually used during the claim period in Line 1. If you are not a licensed distributor or supplier, use Column A to report the
gallons on which you paid the tax more than one year ago, but less than two years ago, and use Column B to report your
gallons on which the tax was paid one year ago or less. Licensed distributors and suppliers may only claim the gallons on
which the tax was paid one year ago or less (Column B).
Column A
Column B
Column C
Column D
Column E
Tax rate
Column F
Net refund
(80%)
(100%)
Total gallons
Highway
Nonhighway
per gallon
More than 1 year
Less than 1 year
gallons
gallons
less than 2 years
7
Gasoline
+
=
-
=
x
= $
______________
______________
________________
_______________
_______________
19¢ (.19)
____________
8
Undyed diesel fuel
8a
used in commercial vehicles used for both highway and nonhighway purposes
+
=
-
=
x
= $
______________
______________
________________
_______________
_______________
21½¢ (.215)
____________
8b
used in unlicensed commercial vehicles operating only on private property
+
=
-
=
x
= $
______________
______________
________________
_______________
_______________
21½¢ (.215)
____________
.
9
Add the amounts in Lines 7 - 8b, Column F, and write the result. This is your total refund claim amount
$
____________
_______________
_______________
Official Use
Official Use
Step 4: Describe how you used the motor fuel listed in Step 3
10
What was the motor fuel used for? At what locations was it used? Describe in detail. Attach a separate sheet if needed.
___________________________________________________________________
Official use - do not write in this box
___________________________________________________________________
l___l___l___l___l___l___l___l___l
___________________________________________________________________
M
M
D
D
Y
Y
Y
Y
RT
IA
CL
WA
1 - Agriculture
5 - Marine
I.D.
___________________________________________________________________
2 - Construction 6 - Fuel
3 - Industrial
7 - Lawn
___________________________________________________________________
4 - Railroad
This form is authorized as outlined by the Motor Fuel Tax Law. Failure to disclose this information could result
in this form not being processed. This form has been approved by the Forms Management Center. IL-492-1542
RMFT-11 Page 1 of 4 (R-1/2000)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial