Form Rmft-11 - Illinois Motor Fuel Tax Refund Claim

Form Rmft-11 - Illinois Motor Fuel Tax Refund Claim - 2000 Page 4

Step 8: Itemize your equipment

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

Dyed

Undyed

Auto

Truck

Tractor

Misc.

Print the make, year, horsepower, etc.

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:

Do not use this claim form to claim a refund for fuel used for aviation purposes.

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 Page 4 of 4 (R-1/2000)

Form Rmft-11 - Illinois Motor Fuel Tax Refund Claim - 2000 Page 4