Form Rmft-10, Schedule E - Mft, Ust, And Eif Tax- And Fee-Paid Purchases - Illinois Department Of Revenue

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Illinois Department of Revenue
Page ____ of ____
Schedule E
MFT, UST, and EIF
Tax- and Fee-Paid Purchases
Attach to Form RMFT-5 or Form RMFT-5-US
Step 1: Complete the following information
_______________________________________________
Check the tax/fee type you are listing on this page.
Check the product type you are listing on this page.
Company name
Gasoline products
MFT-paid only
_______________________________________________
Your license number
UST-/EIF-paid only
Combustible gases
Alcohol
Reporting period __ __/__ __ __ __
Both MFT- and UST-/EIF-paid
Month
Year
Step 2: Report your tax- and fee-paid purchases
1
2
3
4
5
6
7
8
9
Invoice date
Invoice
Name of
Bill of lading or
Origin
Destination
Seller’s
Invoiced
number
carrier
manifest number
Name of seller
(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 See instructions.
12
________________
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-492-0081
RMFT-10 front (R-3/01)

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