Schedule Se - Mft, Ust, And Eif Tax- And Fee-Paid Purchases Of Undyed Fuels At Diesel Fuel Tax Rate

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MFT, UST, and EIF
Page ____ of ____
Illinois Department of Revenue
Schedule SE
Tax- and Fee-Paid Purchases of
Undyed Fuels at Diesel Fuel Tax Rate
Attach to Form RMFT-5 or Form RMFT-5-US
Step 1: Complete the following information
_______________________________________________
Check the tax/fee type you are listing on this page.
Check the product type you are listing on this page.
Company name
MFT-paid only
Special fuel (excluding dyed diesel fuel)
_______________________________________________
UST-/EIF-paid only
1-K kerosene
Your license number
Other (specify:_________________________)
Reporting period __ __/__ __ __ __
Both MFT- and UST-/EIF-paid
Month
Year
Step 2: Report your tax- and fee-paid purchases
1
2
3
4
5
6
7
8
9
Invoice date
Invoice
Name of
Bill of lading or
Name of seller
Origin
Destination
Seller’s
Invoiced gallons
number
carrier
manifest number
(Illinois cities only)
(Illinois cities only)
license number
(see instructions)
(month, day, year)
1
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
2
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
3
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
4
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
5
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
6
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
7
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
8
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
9
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
10
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
11 Add the invoiced gallons in Column 9, Lines 1 through 10, and enter the total here.
11
________________
12 If you are filing only one Schedule SE, enter the amount from Line 11 here.
12
________________
If you are reporting special fuel or other product type
• MFT-paid gallons only, also enter this amount on Form RMFT-5, Lines 2b and 17, Column 2.
• UST-/EIF-paid gallons only, also enter this amount on Form RMFT-5-US, Lines 2b and 12, Column 1.
• both MFT- and UST-/EIF-paid gallons, also enter this amount on Form RMFT-5, Lines 2b and 17, Column 2, and Form RMFT-5-US, Lines 2b and 12, Column 1.
If you are reporting 1-K kerosene, LNG, or Propane product type, enter this amount on Form RMFT-5, Line 17, Column 2.
If you are filing more than one Schedule SE, see instructions.
This form is authorized as outlined by the Motor Fuel Tax Law. Disclosure of this information is REQUIRED.
Failure to provide information could result in a penalty.
RMFT-10-SF (R-06/17)

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