Form Rmft-29 - Schedule M - Mft, Ust, And Eif Products Used For Blending

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Illinois Department of Revenue
Page ____ of ____
Schedule M
MFT, UST, and EIF
Products Used for Blending
Attach to Form RMFT-5
Step 1: Complete the following information
______________________________________________
Company name
______________________________________________
Your license number
Reporting period __ __/__ __ __ __
Month
Year
Step 2: Report your blending activity
(In “Other” column write the exact name of the product immediately above the number of gallons.)
1
2
3
4
Primary product gallons
Blending agent gallons
Total end product gallons
a
b
c
a
b
c
a
b
Blended date
Gasoline
Diesel
Alcohol
Gasohol
(Gas)
(DSL)
Other
(ALC)
Other
Other
(GHL)
Other
(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-492-1539
RMFT-29 front (R-02/00)

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