Form Rmft-5-Us-X - Amended Return/claim For Credit Underground Storage Tank Tax And Environmental Impact Fee
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Illinois Department of Revenue
RMFT-5-US-X
Amended Return/Claim for Credit
Underground Storage Tank Tax and Environmental Impact Fee
Sequence no. ______
Station no. 590
Do not write above this line.
Step 1: Identify yourself
Name _______________________________________________
Original reporting period ___________/__ __ __ __
Month
Year
Address_______________________________________________
Receiver license number ____________________
R
-
Number and street
______________________________________________________
Telephone no. (__ __ __) __ __ __ - __ __ __ __
City State
ZIP
As originally reported
Corrected
Note: You must report your fuel in gallons. Convert liters to gallons by
multiplying liters by .2641721. Follow our instructions for each column.
or adjusted
amounts
Column 1
Column 2
Column 1
Column 2
Gasoline and
Gasoline and
Step 2: Figure your total gallonage for the month
special fuel
Other fuels
special fuel
Other fuels
1 Write your actual (stick) inventory at the beginning of the month. This
amount must agree with closing inventory of preceding month’s return.
1
2 Write the number of invoiced gallons produced, acquired, received or
transported into Illinois during the month
a Tax/fee-free invoiced gallons
2a
(Sch. A, SA, or DA, Column 1; Sch. LA, Column 2)
b Tax/fee-paid invoiced gallons
2b
(Schedule E, SE, or LE (dyed diesel fuel), Column 1; other fuels, Sch. LE, Column 2)
3 Add Lines 1 through 2b and write the result in Line 3. Remember to do
3
calculations within each column.
4 Write your actual (stick) inventory at the end of the month.
4
5 Subtract Line 4 from Line 3 and write the result on Line 5.
5
Step 3: Figure your nontaxable gallonage
6 Write the number of gallons sold exempt in Illinois
///////////////////
///////////////////
a to railroads for direct rail operation
6a
(Schedule LB)
b to qualified air carriers
6b
(Schedule LB, kerosene, Column 1; other fuels, Column 2)
///////////////////
///////////////////
c to qualified ships, barges, and vessels
6c
(Schedule LB)
7 Write the number of gallons sold and delivered outside of Illinois
7
(Schedule C, SC, DC, Column 1; Schedule LC, Column 2)
8 Write the number of gallons sold and distributed tax/fee-free to licensed
8
receivers
(Schedule D, SD, or DD, Column 1; Schedule LD, Column 2)
9 Write the number of gallons of your loss due to temperature variation or evaporation
or your gain due to temperature variation. Complete Line 9a or 9b per column.
a Loss.
9a
The amount of losses you claim are limited. See instructions.
or
(
) (
)
(
) (
)
b Gain.
9b
10 Add Lines 6a through 9b and write the result on Line 10.
10
This is your total nontaxable gallonage.
Step 4: Figure your gross taxable gallonage
11 Subtract Line 10 from Line 5 and write the result on Line 11.
This is your gross taxable gallonage.
11
Step 5: Figure your net taxable gallonage
12 Write the number of gallons on which tax/fee was paid at the time of purchase. 12
13 Subract Line 12 from Line 11 and write the result on Line 13.
13
14 Add Line 13, Column 1 and Line 13, Column 2.
This is your net taxable gallonage.
14
This form is authorized by the Motor Fuel Tax Law and Environmental Impact Fee Law. Disclosure of this information is REQUIRED. Failure
to comply may result in a penalty. This form has been approved by the Forms Management Center. IL-492-2337
RMFT-5-US-X Page 1 (R-05/11)
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