Form Rmft-5-X - Amended Return/claim For Credit Motor Fuel Tax For Distributor/suppliers Page 2

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Form RMFT-5-X Page 2

As originally reported or adjusted

Corrected amounts

Follow our instructions for each column.

Step 6: Figure your tax

Column 1

Column 2

Column 3

Column 1

Column 2

Column 3

19 Figure your gross tax due. If the amount of Line 18 is greater than zero, write

Gasoline &

Special fuel except

Gasoline &

Special fuel except

combustible gases

dyed diesel fuel

Dyed diesel fuel

combustible gases

dyed diesel fuel

Dyed diesel fuel

the amount from Line 18. Otherwise, write “0” in Lines 19 - 21 within the column.

X 0.19. Write the result in Column 1, Line 19.

Column 1, Line 18

X 0.215. Write the result in Column 2, Line 19.

19 $

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Column 2, Line 18

20 If you originally filed and paid your tax due on time, figure your collection

discount. See instructions.

Note: If you are increasing the amount of tax due, you may not increase the amount

of your discount unless the increased tax due is paid on or before the due date

of the original return. If you are decreasing the amount of tax due, refigure the

amount of the discount to which you are entitled based on your new figures.

20 $

////////////////////

21 Subtract Line 20 from Line 19. This is your net tax due by fuel type.

21 $

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22 Add Column 1, Line 21 and Column 2, Line 21. This is your tax due.

22 $

Step 7: Figure the amount you owe

23 Complete this line if you have a motor fuel tax (MFT) credit you wish to apply to Line 22, tax due.

Official use - do not write in this box

MFT credit no.

MFT credit amt. $

23 $

Add these MFT credit amounts and write the total on Line 23.

24 Subtract Line 23 from Line 22.

24 $

25 Total amount paid to date for this reporting period.

25 $

26 If Line 24, Corrected Amounts Column, is greater than Line 25, subtract Line 25 from

Line 24, Corrected Amounts Column. This is the amount you owe.

26 $

27 If Line 24, Corrected Amounts Column, is less than Line 25, subtract Line 24, Corrected

Amounts Column, from Line 25. If you want to claim a credit, you must complete Step 9.

27 $

Step 8: Sign and date your amended return

Under penalties of perjury, I state that I have examined this amended 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

Taxpayer’s name

Preparer’s phone number

Signature and title of taxpayer

Date

Mail this return and payment to: Illinois Department of Revenue, PO Box 19019, Springfield, IL 62794-9019

Step 9: Complete your claim for credit -

Complete Lines 28 through 30 if you are claiming a credit.

28 Explain below why the amount for which the claim is filed is alleged to be a mistake of fact or an error in law. Attach additional sheets if you need more space to write in.

Official use only. Do not write in this box.

29 Are you a party to any civil suits involving the above amounts?

yes

Credit memo no.

If yes, what is the name of the suit?

Credit amount

Interest

30 Sign below

Total

Verified by

Date

Signature of claimant