Form RMFT-5-X Amended Return/Claim for Credit Motor Fuel Tax for Distributor/Supplier - Illinois

Form RMFT-5-X or the "Amended Return/claim For Credit Motor Fuel Tax For Distributor/supplier" is a form issued by the Illinois Department of Revenue.

The form was last revised in June 1, 2017 and is available for digital filing. Download an up-to-date Form RMFT-5-X in PDF-format down below or look it up on the Illinois Department of Revenue Forms website.

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Illinois Department of Revenue
RMFT-5-X
Amended Return/Claim for Credit
REV 01
E S ___/___/___
Motor Fuel Tax for Distributor/Supplier
NS DP CA
Step 1: Identify yourself
Do not write above this line.
D
-
Name_________________________________________________
Original reporting period ___________/__ __ __ __
Distributor license number
OR
Month
Year
-
S
Address_______________________________________________
Supplier license number
Number and street
______________________________________________________
Telephone no. (__ __ __) __ __ __ - __ __ __ __
City
State
ZIP
As originally reported or adjusted
Corrected amounts
Note: All calculations of tax are based on gallon measurements (i.e., a liquid gallon, a gasoline
gallon equivalent, or a diesel gallon equivalent). For more information, see instructions for each column.
Column 1
Column 2
Column 3
Column 1
Column 2
Column 3
Step 2: Figure your total gallonage for the month
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Tax Rate
Tax Rate
1 Enter your actual (stick) inventory at the beginning of the month. This
1
amount must agree with closing inventory of preceding month’s return.
2 Enter the number of gallons
a produced, acquired, received or transported into Illinois tax-free
2a
(Schedule A, SA, or DA)
b produced, acquired, received or transported into Illinois tax-paid
2b
(Schedule E or SE)
//////////////////////
//////////////////////
c of combustible gases/1-K kerosene/alcohol sold for highway use
2c
(Schedule GA-1)
3 Add Lines 1 through 2c. Remember to do calculations within each column.
3
4 Enter your actual (stick) inventory at the end of the month.
4
5 Subtract Line 4 from Line 3. This is your net gallonage for the month.
5
Step 3: Figure your nontaxable gallonage
6 Enter the number of gallons sold to the federal government,etc.
6
(Schedule B, SB, or DB)
7 Enter the number of gallons exported from Illinois
7
(Schedule C, SC, or DC)
8 Enter the number of gallons
a sold and distributed tax-free to a distributor or supplier
8a
(Schedule D, SD, or DD)
//////////////////////
//////////////////////
//////////////////////
//////////////////////
b sold and distributed tax-free to other than a distributor or supplier
8b
(Schedule DD-1)
//////////////////////
//////////////////////
//////////////////////
//////////////////////
c of dyed diesel fuel you used for nonhighway purposes
8c
9 Enter the number of gallons lost due to fire, leakage, spillage, etc.
9
(Schedule F)
10 Enter the number of gallons of your loss due to temperature variation or evaporation
or your gain due to temperature variation. Complete Line 10a or 10b per column.
a Loss. The amount of losses you claim are limited. See instructions.
10a
or
(
) (
) (
)
(
) (
) (
)
b Gain.
10b
11 Add Lines 6 through 10b. This amount is your total nontaxable gallonage.
11
12 Subtract Line 11 from Line 5. The amount in Column 3 should be zero.
12
Steps 4 & 5: Figure your taxable gallonage
//////////////////////
//////////////////////
13 Enter the number of gallons sold and distributed for taxable purposes.
13
14 Enter the number of gallons you used in motor vehicles on public highways
//////////////////////
//////////////////////
or for operating recreational-type watercraft on waters of Illinois.
14
//////////////////////
//////////////////////
15 Enter the number of gallons you used for nontaxable (nonhighway) purposes.
15
//////////////////////
//////////////////////
16 Add Lines 13, 14, and 15. This is your gross taxable gallonage.
16
//////////////////////
//////////////////////
17 Enter the number of gallons on which tax was paid at the time of purchase.
17
(Schedule E or SE)
//////////////////////
//////////////////////
18 Subtract Line 17 from Line 16. This is your net taxable gallonage.
18
RMFT-5-X Page 1 (R-06/17)
Illinois Department of Revenue
RMFT-5-X
Amended Return/Claim for Credit
REV 01
E S ___/___/___
Motor Fuel Tax for Distributor/Supplier
NS DP CA
Step 1: Identify yourself
Do not write above this line.
D
-
Name_________________________________________________
Original reporting period ___________/__ __ __ __
Distributor license number
OR
Month
Year
-
S
Address_______________________________________________
Supplier license number
Number and street
______________________________________________________
Telephone no. (__ __ __) __ __ __ - __ __ __ __
City
State
ZIP
As originally reported or adjusted
Corrected amounts
Note: All calculations of tax are based on gallon measurements (i.e., a liquid gallon, a gasoline
gallon equivalent, or a diesel gallon equivalent). For more information, see instructions for each column.
Column 1
Column 2
Column 3
Column 1
Column 2
Column 3
Step 2: Figure your total gallonage for the month
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Tax Rate
Tax Rate
1 Enter your actual (stick) inventory at the beginning of the month. This
1
amount must agree with closing inventory of preceding month’s return.
2 Enter the number of gallons
a produced, acquired, received or transported into Illinois tax-free
2a
(Schedule A, SA, or DA)
b produced, acquired, received or transported into Illinois tax-paid
2b
(Schedule E or SE)
//////////////////////
//////////////////////
c of combustible gases/1-K kerosene/alcohol sold for highway use
2c
(Schedule GA-1)
3 Add Lines 1 through 2c. Remember to do calculations within each column.
3
4 Enter your actual (stick) inventory at the end of the month.
4
5 Subtract Line 4 from Line 3. This is your net gallonage for the month.
5
Step 3: Figure your nontaxable gallonage
6 Enter the number of gallons sold to the federal government,etc.
6
(Schedule B, SB, or DB)
7 Enter the number of gallons exported from Illinois
7
(Schedule C, SC, or DC)
8 Enter the number of gallons
a sold and distributed tax-free to a distributor or supplier
8a
(Schedule D, SD, or DD)
//////////////////////
//////////////////////
//////////////////////
//////////////////////
b sold and distributed tax-free to other than a distributor or supplier
8b
(Schedule DD-1)
//////////////////////
//////////////////////
//////////////////////
//////////////////////
c of dyed diesel fuel you used for nonhighway purposes
8c
9 Enter the number of gallons lost due to fire, leakage, spillage, etc.
9
(Schedule F)
10 Enter the number of gallons of your loss due to temperature variation or evaporation
or your gain due to temperature variation. Complete Line 10a or 10b per column.
a Loss. The amount of losses you claim are limited. See instructions.
10a
or
(
) (
) (
)
(
) (
) (
)
b Gain.
10b
11 Add Lines 6 through 10b. This amount is your total nontaxable gallonage.
11
12 Subtract Line 11 from Line 5. The amount in Column 3 should be zero.
12
Steps 4 & 5: Figure your taxable gallonage
//////////////////////
//////////////////////
13 Enter the number of gallons sold and distributed for taxable purposes.
13
14 Enter the number of gallons you used in motor vehicles on public highways
//////////////////////
//////////////////////
or for operating recreational-type watercraft on waters of Illinois.
14
//////////////////////
//////////////////////
15 Enter the number of gallons you used for nontaxable (nonhighway) purposes.
15
//////////////////////
//////////////////////
16 Add Lines 13, 14, and 15. This is your gross taxable gallonage.
16
//////////////////////
//////////////////////
17 Enter the number of gallons on which tax was paid at the time of purchase.
17
(Schedule E or SE)
//////////////////////
//////////////////////
18 Subtract Line 17 from Line 16. This is your net taxable gallonage.
18
RMFT-5-X Page 1 (R-06/17)
Form RMFT-5-X Page 2
As originally reported or adjusted
Corrected amounts
Follow our instructions for each column.
Column 1
Column 2
Column 3
Column 1
Column 2
Column 3
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Gasoline Tax Rate
Diesel Fuel
Dyed diesel fuel
Step 6: Figure your tax
Tax Rate
Tax Rate
19 Figure your gross tax due. If the amount on Line 18 is greater than zero, enter
the amount from Line 18. Otherwise, enter “0” on Lines 19 - 21 within the column.
a
X 0.19. Enter the result on Line 19, Column 1.
Column 1, Line 18
b
19 $
////////////////////
X 0.215. Enter the result on Line 19, Column 2.
////////////////////
$
$
$
$
$
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
////////////////////
20 $
amount of the discount to which you are entitled based on your new figures.
$
$
$
$
$
////////////////////
21 Subtract Line 20 from Line 19. This is your net tax due by fuel type.
21 $
$
$
////////////////////
$
$
$
////////////////////
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 Enter the amount of credit you wish to apply. (See instructions.)
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 you are filing this claim is alleged to be a mistake of fact or an error in law. Attach additional sheets, if necessary.
29 Are you a party to a civil suit involving the above amounts?
yes
no
If “yes”, what is the name of the suit?
30 Sign below
Signature of claimant
Title (Indicate whether owner, partner, officer, or authorized agent)
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.
RMFT-5-X Page 2 (R-06/17)

Download Form RMFT-5-X Amended Return/Claim for Credit Motor Fuel Tax for Distributor/Supplier - Illinois

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