Form Rmft-5-Us - Underground Storage Tank Tax And Environmental Impact Fee Receiver Return
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Illinois Department of Revenue
RMFT-5-US
Underground Storage Tank Tax and
Environmental Impact Fee Receiver Return
Station no. 591
Do not write above this line.
Step 1: Identify yourself
Name _______________________________________________
Reporting period ___________/__ __ __ __
Month
Year
R
-
Address_______________________________________________
Receiver license number ____________________
Number and street
______________________________________________________
Telephone no. (__ __ __) __ __ __ - __ __ __ __
City
State
ZIP
Note: You must report your fuel in gallons. Convert liters to gallons by
Column 1
Column 2
multiplying liters by .2641721. Follow our instructions for each column.
Gasoline and
special fuel
Other fuels
Step 2: Figure your total gallonage for the month
1 Write your actual (stick) inventory at the beginning of the month. This amount must
1
agree with closing inventory of preceding month’s return.
2 Write the number of invoiced gallons produced, acquired, received or transported
into Illinois during the month
a Tax/fee-free invoiced gallons
2a
(Schedule A, SA, or DA, Column 1; Schedule LA, Column 2)
b Tax/fee-paid invoiced gallons
2b
(Schedule E, SE, or LE (dyed diesel), Column 1; other fuel, Schedule LE, Column 2)
3 Add Lines 1 through 2b and write the result in Line 3. Remember to do calculations
within each column.
3
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. You must account
for your nontaxable and taxable gallonage within Step 3 and Step 4.
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 fuel, 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, or LC)
8 Write the number of gallons sold and distributed tax/fee-free to licensed receivers
8
(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. The amount of losses you claim are limited. See instructions.
9a
or
(
) (
)
b Gain.
9b
10 Add Lines 6a through 9b and write the result on Line 10.
This is your total nontaxable gallonage.
10
Step 4: Figure your gross taxable gallonage
11 Subtract Line 10 from Line 5 and write the result on Line 11.
11
This is your gross taxable gallonage.
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 Subtract Line 12 from Line 11 and write the result on Line 13.
This is your net taxable gallonage by fuel type.
13
14 Add Line 13, Column 1 and Line 13, Column 2 and write the result on Line 14.
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-492-2814
RMFT-5-US Page 1 (R-05/11)
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