Schedule Ga-1 (Form Rmft-112) - Motor Fuel Tax Alcohol, Compressed Gases, Or 1-K Kerosene Sold In Illinois As Motor Fuel

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Illinois Department of Revenue
Motor Fuel Tax
Page ____ of ____
Schedule GA-1
Alcohol, Compressed Gases, or 1-K Kerosene
Sold in Illinois as Motor Fuel
Attach to Form RMFT-5
Step 1: Complete the following information
Check the product type you are listing on this page.
_______________________________________________
Company name
LP gas
_______________________________________________
Alcohol
Your license number
1-k kerosene
Reporting period __ __/__ __ __ __
Other (specify: _________________________)
Month
Year
Step 2: Report your tax-paid sales
1
2
3
4
5
6
7
8
9
Invoice date
Invoice
Name of
Bill of lading or
Origin
Destination
Purchaser’s
Invoiced
number
carrier
manifest number
Name of purchaser
(Illinois cities only) (Illinois cities only)
license number
gallons
(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 write the total here.
11
_________________
12 If you are filing only one Schedule GA-1, write the amount from Line 11 here.
12
_________________
If you are reporting
• LP gas, alcohol, or combustible gases, also write this amount on Form RMFT-5, Line 2c, Column 1.
• 1-k kerosene, also write this amount on Form RMFT-5, Line 2c, Column 2.
If you are filing more than one Schedule GA-1, 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. This form has been approved by the Forms Management Center.
IL-492-1526
RMFT-112 front (R-5/99)

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