Schedule J (Attachment To Form Rmft-5) - Motor Fuel Tax Petroleum Products Received In Illinois For Refining Purposes

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Illinois Department of Revenue
Motor Fuel Tax
Page ____ of ____
Schedule J
Petroleum Products Received in
Illinois for Refining Purposes
Attach to Form RMFT-5
Step 1: Complete the following information
Check the product type you are listing on this page.
_______________________________________________
Gasoline
Company name
Special fuel (excluding dyed diesel fuel)
_______________________________________________
Dyed diesel fuel
Your license number
Reporting period __ __/__ __ __ __
Other (specify: _________________________)
Month
Year
Step 2: Report your refinery receipts
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
(city and state)
(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. Write the total amount here.
11
_______________
12 If you are filing only one Schedule J, write the amount from Line 11 here.
12
_______________
If you are filing more than one Schedule J, add Line 11 from each schedule, and write the total on Line 12 of the last page.
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. This form has been approved by the Forms Management Center.
IL-492-1540
RMFT-24 front (R-12/99)

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