Form Rmft-5-Sfb - Bulk User'S Tax Return 1999

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Illinois Department of Revenue
RMFT-5-SFB
Bulk User’s Tax Return
Do not write above
Step 1: Identify yourself
this
line.
Name
________________________________________________
Reporting period
__ __/__ __ __ __ through __ __/__ __ __ __
Month
Year
Month
Year
Address ________________________________________________
Bulk user’s number ______________________________________
Number and street
_______________________________________________________Telephone number
(_______)_____________________________
City
State
ZIP
Step 2: Report your special fuel purchases delivered into bulk storage
Do not report gasoline, retail outlet purchases, or fuel delivered directly into equipment.
1
2
3
4
5
6
7
8
Invoice date
Invoice
Address of receipt
Seller’s
Invoiced
IL motor fuel
(month, day, year)
number
Name of seller
(number and street, city and state) license number
gallons
tax paid?
No
Yes
[
]
1
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
2
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
3
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
4
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
5
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
6
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
7
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
8
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
9
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
[
]
10
_ _/_ _/_ _ _ _ ___________ ________________________ ________________________ ____________ ____________ ____ ____
________________________
11
11
Add the invoiced gallons in Column 6, and write the total here.
____________
12
12
Add Line 11 above and Line 15 from all RMFT-5-SFB Supplemental Returns you are filing, and write the total here.
______________
Step 3: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct and complete.
________________________________________________________________
______________________________________________________________
Signature of person, other than taxpayer, who prepared this return
Date
Company name
Mail your return to: MOTOR FUEL TAX
______________________________________________________________
Signature and title
Date
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
If you have questions, call 217 782-2291.
RMFT-5-SFB front (R-6/99)

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