Form Rmft-29, Schedule M - Special Fuels

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Illinois Department of Revenue
Page ____ of ____
Schedule M — Special Fuels
MFT, UST, and EIF
Products Used for Blending
Attach to Form RMFT-5
Step 1: Complete the following information
Do not report gasoline blending on this
______________________________________________
schedule. Use Schedule M—Gasoline.
Company name
______________________________________________
Your license number
Reporting period __ __/__ __ __ __
Month
Year
Step 2: Report your blending activity
(If Column 3c or 4b is used, write the exact name of the product on the line provided.)
1
2
3
4
Primary product gallons
Blending agent gallons
Total end product gallons
(Report one product type per page)
a
b
c
a
b
c
a
b
Blended date
Undyed
Dyed
Other (Identify)
Other (Identify)
Bio/Petro
Other (Identify)
Diesel
Diesel
_______________
B100/Soy Oil
1-K Kerosene
_______________
Diesel Blend
_______________
(month, day, year)
1
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
2
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
3
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
4
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
5
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
6
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
7
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
8
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
9
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
10
_ _/_ _/_ _ _ _ ____________________________________________________________________________________________________________________________________
11
Add Lines
1 through 10.
____________________________________________________________________________________________________________________________________
12
See
instructions.
____________________________________________________________________________________________________________________________________
This form is authorized as outlined by the Motor Fuel Tax Law and the Environmental Impact Fee 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-492-4343
RMFT-29-B front (R-1/03)

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