Form Rmft-5-Us-X - Amended Return/claim For Credit Underground Storage Tank Tax And Environmental Impact Fee Page 2
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2Form RMFT-5-US-X Page 2
As originally reported
Corrected
Step 6: Figure your tax and fee
or adjusted
amounts
15 Figure your gross tax and fee due. If the amount of Line 14 is greater than zero,
write the amount from Line 14 on the line provided below and multiply by the tax
and fee rates provided. Otherwise, write “0” in Lines 15a, 15b, and 15c.
a For underground storage tank tax:
X 0.003.
15a $
$
Line 14, Col. 2
b For environmental impact fee:
X 0.008.
15b $
$
Line 14, Col. 2
c Add Lines 15a and 15b. This is your gross tax and fee due.
15c $
$
16 If you originally filed and paid your tax and fee due on time, figure your
16 $
collection discount. See instructions.
$
17 Subtract Line 16 from Line 15c and write the result on Line 17.
This is your tax and fee due.
17 $
$
Step 7: Figure the amount you owe
18 Complete this line if you have a UST/EIF credit you wish to apply to Line 17, tax
Official use - do not write in this box
and fee due, and any penalty and interest you owe.
Write the credit memorandum number of each credit you are applying and the
total amount of that credit on the line directly below the credit number.
UST/EIF credit no.
UST/EIF credit amt.
$
$
$
$
$
Add these UST/EIF credit amounts and write the total on Line 18.
18 $
$
19 Subtract Line 18 from Line 17 and write the result on Line 19. This is
the tax/fee due.
19 $
$
20 Total amount paid to date for this reporting period.
20 $
21 If Corrected Amounts Column, Line 19 is greater than Line 20,
subtract Line 20 from Line 19. This is the amount you owe.
Make your check payable to “Illinois Department of Revenue.”
21 $
22 If Corrected Amounts Column, Line 19 is less than Line 20,
subtract Line 19 from Line 20. If you are claiming a credit, you must
complete Step 9.
22 $
Step 8: Sign and date your amended return
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
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 23 through 25 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.
29 Are you a party to any civil suits involving the above amounts?
yes
no
If yes, what is the name of the suit?
Official use only. Do not write in this box.
30 Sign below
Credit memo no.
Credit amount
Signature of claimant
Interest
Total
Verified by
Title (State whether owner, partner, or authorized agent)
Date
Approved by
Date
RMFT-5-US-X Page 2 (R-05/11)
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