Form RMFT-22 Common Carrier's Report of Motor Fuel Delivered - Illinois

Form RMFT-22 or the "Common Carrier's Report Of Motor Fuel Delivered" is a form issued by the Illinois Department of Revenue.

Download a PDF version of the Form RMFT-22 down below or find it on the Illinois Department of Revenue Forms website.

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Illinois Department of Revenue
Page ____ of ____
RMFT-22
Common Carrier’s Report of Motor Fuel Delivered
Read this information first
This report covers one calendar month. This report must be filed monthly and is due 30 days after the close of the month being reported. Send your report to:
ILLINOIS DEPARTMENT OF REVENUE, PO Box 19019, Springfield IL, 62794-9019
You must submit this report as a separate mailing. Do not send this report with any other report or return.
Step 1: Identify your business
Name: __________________________________________________________________
Address: ________________________________________________________________
City, State, ZIP: ___________________________________________________________
Reporting period: _____/__________
MM
YYYY
Transportation method:
Truck
_____
IDOT No: __________________________
Barge
_____
Barge ID: __________________________
(choose one)
Pipeline _____
Terminal location: ____________________
Train
_____
Train ID: ___________________________
Other
_____
Describe: ______________________________________________________________________________________
Step 2: Enter the following information for each intrastate and interstate shipment of motor fuel delivered at points in
the state of Illinois —
Each car or shipment must be shown as a separate entry.
Bill of Lading
Name of Consignor
Point of Origin
Products
Gallons
Name of Consignee
Date Delivered
Point of Delivery
This form is authorized as outlined by Section 7b of the Motor Fuel Tax Law. Disclosure
RMFT-22 (R-03/17)
of this information is required. Failure to provide information may result in a fine.
Illinois Department of Revenue
Page ____ of ____
RMFT-22
Common Carrier’s Report of Motor Fuel Delivered
Read this information first
This report covers one calendar month. This report must be filed monthly and is due 30 days after the close of the month being reported. Send your report to:
ILLINOIS DEPARTMENT OF REVENUE, PO Box 19019, Springfield IL, 62794-9019
You must submit this report as a separate mailing. Do not send this report with any other report or return.
Step 1: Identify your business
Name: __________________________________________________________________
Address: ________________________________________________________________
City, State, ZIP: ___________________________________________________________
Reporting period: _____/__________
MM
YYYY
Transportation method:
Truck
_____
IDOT No: __________________________
Barge
_____
Barge ID: __________________________
(choose one)
Pipeline _____
Terminal location: ____________________
Train
_____
Train ID: ___________________________
Other
_____
Describe: ______________________________________________________________________________________
Step 2: Enter the following information for each intrastate and interstate shipment of motor fuel delivered at points in
the state of Illinois —
Each car or shipment must be shown as a separate entry.
Bill of Lading
Name of Consignor
Point of Origin
Products
Gallons
Name of Consignee
Date Delivered
Point of Delivery
This form is authorized as outlined by Section 7b of the Motor Fuel Tax Law. Disclosure
RMFT-22 (R-03/17)
of this information is required. Failure to provide information may result in a fine.

Download Form RMFT-22 Common Carrier's Report of Motor Fuel Delivered - Illinois

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