( 

( 

APPENDIXD: 

Sample Sales Tax Returns 

ST-1 Sales and Use Tax and E911 Surcharge Return 

ST-1-X Amended Sales and Use Tax and E9 l l Surcharge Rehm1 

RMFT-5-US Underground Storage Tank Tax and Environmental Impact Fee Receiver Return 

RMFT-5-US-X Amended Return/Claim for Credit Underground Storage Tank Tax and 

Environmental Impact Fee 

Schedule C 

Schedule D 

Schedule E 

Schedule DA 

Schedule DD 

Schedule LA 

Schedule LB 

Schedule LC 

Schedule LD 

Schedule LE 

Schedule SA 

Schedule SD 

Schedule SE 
( 
( 

( 

Illinois Department of Revenue 

RMFT-5-US Underground Storage Tank Tax and 

Environmental Impact Fee Receiver Return 

REV 01 

ES 

NS OP CA 

Do""' ,.,,,ie ab<>1•e th·r· ,o~ 

Step 1 : Identify yourself 

Name Reporting period-~~--/ Month - Yea,- -

Address~-----

Nu~ber and street 

Receiver license number ~R~-------~ 

Telepl1one no.( ___ ) ___ - ___ _ 

c,, Si ate 2'P 

Note: You must report your fuel in gallons. Convert liters to gallons by 

multiplying liters by .2641721. Follow our instructions for each column. 

Step 2: Figure your total gallonage for the month 

Column 1 

Gasoline and 

spe;::1al fuel 

1 Enter your actual (stick) inventory at the beginning of the month. This amount must 1 -----

agree with closing inventory of preceding rnonth·s return. 

2 Enter the number of invoiced gallons produced, acquired. received or transported 

into Illinois during the month 

a Tax/fee-free invoiced gallons 1scr~du1.e A. SA 0° DA. Cclurnn 1. sc~ed~ta LA. Column 21 2a -----

b Tax/fee-paid invoiced gallons1s~~ed~J,a E. sec. or LE 1dyej d,esell. Co!u'Tir 1. other fuel. Sch:,j~le LE. Column 21 2b -----

3 Add Lines 1 through 2b and enter the result in Line 3. Remember to do calculations 

within each column. 3 -----

4 Enter your actual (stick) inventory at the end of the month. 4 -----

5 Subtract Line 4 from Line 3 and enter the result on Line 5. You must account 

for your nontaxable and taxable gallonage within Step 3 and Step 4. 

Step 3: Figure your nontaxable gallonage 

6 Enter the number of gallons sold exempt in Illinois 

a to railroads for direct rail operation 1schectu1e LBJ 

b to qualified air carriers 1s~M.adule LB, ~erose~e. Column 1. other ruel, Co:umn 21 

c to qualified ships, barges, and vessels (Scr.edule LB1 

7 Enter the number of gallons sold and delivered outside of !l!inois (Schedu:.ac. sc, DC. or LC) 

8 Enter the number of gallons sold and distributed tax/fee-free to licensed receivers 

(Sci'edule D, SD, or DD, Coi~m" 1, Sc~edJle LO. Columr 2) 

9 Enter the number of gallons of your loss due to temperature variation or evaporation 

or your gain due to temperature variation. Complete Line 9a or 9b per column. 

5 

6a 

6b 

6c 

7 

8 

Column 2 

Other iuels 

!!II!/// if/iii Ii I Ill! I 

lll!l!l!!l!llllll/1/II 

a Loss. The amount of tosses you claim are limited. See instructions. or 9a ~---- ----- b Gain. 9b I I ~I---~ 

1 o Add Lines 6a through 9b and enter the result on Line 10. 

This is your total nontaxable gallonage. 

Step 4: Figure your gross taxable gallonage 

11 Subtract Line 10 from Line 5 and enter the result on Line 11. 

This is your gross taxable gallonage. 

Step 5: Figure your net taxable gallonage 

12 Enter the number of gallons on wh\ch tax/fee was paid at the time of purchase. 

13 Subtract Line 12 from Line 11 and enter the result on Line 13. 

This is your net taxable gallonage by fuel type. 

1 Add Line 13, Column 1 and Line 13, Column 2 and enter the result on Line 14. 

This is your net taxable gallonage. 

10 

11 

12 ----------

13 ----------

14 ______ _ 

RMFT-S·US Paget IR·G6.'15) 

ti·s •crrn is asto~, zed ~s outi1no1 u~oe· the ta, c,r ree c! 1'npos.e'.' the tc,~r ee tor w~ c th,s ..,,, ,s lee<. ioc oswe er th s ,- ormat10~ ·s cgqu:•eO 

Fa,-are to pr,o,iCl~ 1n!c,ma1,on may rnsdt ,~ \h'S foe,~ ml beshQ p'OcessM a,~..,,~, ,eou,1 ,n a re,aity 
Form RMFT-5-US Page 2 

Step 6: Figure your tax and fee 

i5 Figure your gross tax and fee due. If the amount of Line 14 is greater than zero. 

enter the amount from Line 14 on the line provided below and multiply by the tax 

and fee rates provided. Otherwise, enter '·o" in Lines 1 Sa. 15b. and 15c. 

a For underground storage tank tax: X 0.003. 15a s ____ _ Loe ,4 

b For environmental impact fee: -~=-- X 0.008- 1sb s ___ _ ~ne ,~ 

c Add Lines i Sa and i5b. This is your gross tax and fee due. 

16 tf you are filing this return on time and paying your tax and fee due in full. figure 

your 1.75°.-;, collection discount. Multiply Line 1 Sc by 0.0175. 

17 Subtract Line 16 from Line 15c and enter the result on Line 17. 

This is your tax and fee due. 

Step 7: Figure the amount you owe 

18 Enter the amount of credit you wish to apply. (See instructions.) 

19 Subtract Line 18 from Line 17 and enter the result on Line 19. This is the amount 

you owe. Make your check payable to "'Illinois Department of Revenue.'· 

Step 8: Sign and date your return 

15c$, ______ _ 

16$, ______ _ 

17$, ______ _ 

1a s ______ _ 

19 $ ______ _ 

Under penalties of perjury. I state that J have examined this r·eturn and, to the best of my knowledge, it is true, correct, and 

complete. 

S1gm,1u,e of persor. vtrer 1raP taxpayer. wro preparej l~,s ,eturr Dale 

Prepo.rers phore numt,e, Signature ard title of mxpayer Or.le 

Mail this return and payment to: Illinois Department of Revenue, PO Box 19019, Springfield, !L 62794-9019 

Rl.1FT-5-US Pa~a 2 tR-03 15J 
Form RMFT-5-US Instructions 

General Information 

Who must file this return? 

If you are a licensed receiver who first sells or uses fuel for any 

purpose, you must pay the underground storage tank tax (UST} 

and the environmental impact fee {EIF) at the time of such sale or 

use. 

When are the return, schedules, and payment 

due? 

Your return is due on or before the 20111 day of each month for 

the previous month's activity. You must file a return by ihis due 

date even wl1en you make tax- and fee-paid purchases or are 

inactive. Supporting schedules. documents, and payment must 

accompany t11e return. 

Note: lf the due date falls on a weekend or holiday, your payment 

is due the next business day. 

How do I file my return? 

For all reporting periods June 2015 and after. you may file your 

return electronically through MyTax Illinois available on our 

website at tax.illinois.gov. You may pay electronically. 

For all reporting periods May 2015 and prior. make your check 

payable to "Illinois Department of Revenue" and mail your 

completed return and payment to: 

( ,INOIS DEPARTMENT OF REVENUE 

r"0 BOX 19019 

SPRINGFIELD IL 62794-9019 

Write a separate check for paying your Form RMFT-S"US liability. 

Do not combine it with any other liability you owe. 

What if I have additional questions or need 

more information? 

Write to us at the address above or cal! us at our Springfield 

office weekdays between 8:00 a.m. and 4:30 p.m. at 

217 782-2291 or visit our website at tax.illinois.gov. 

What records must I keep? 

You are required by law to keep books and records showing all 

purchases, receipts, sales, distributions, and use of fuel. 

What if I do not comply? 

You owe a late-filing penalty if you do not file a processable 

return by the due date. a late-payment penalty if you do not 

pay the taxltee you owe by the date the tax/fee is due, and a 

bad check penalty if your remittance is not honored by your 

financial institution. Interest is calculated on tax/fee from the day 

after the original due date of your return through the date you pay 

the tax/fee. We will bill you for penalties and interest. For more 

information about penalties and interest. see Publication 103, 

Penalties and Interest for Illinois Taxes, available on our website 

! ax.iUinois.gov. 

If you do not file a return. we may also revoke your license. 

RMFT·5·US l'l.Wuct o~s 1wol (R-J6- 15) 

Specific Instructions 

How do I convert gallons to liters? 

You must report your fuel in gallons. Convert liters lo gallons by 

multiplying liters by .2641721. 

Line 2a • 

Column 1 - Enter the number of UST-/EIF-free gallons of 

gasoline and special fuel from Schedules A, SA, or DA. 

Column 2 - Enter the number oi UST-/EIF-free gallons of 

other fuels from Schedule LA. 

Line 2b • 

Column 1 · Enter the number oi UST-/EIF-paid gallons of 

gasoline and special fuel from Schedules E and SE. Also 

include your gallons of dyed diesel from Schedule LE. 

Column 2 - Enter the number of UST-IE IF-paid gallons of 

other fuels from Schedule LE. 

Line Ga - Enter the number of UST-/EIF-free gallons of diesel 

fuel you sold to qualified railroads for direct rail operation from 

Schedule LB in Column 1. 

Line 6b ~ Enter the number of UST-/EIF-free gallons of kerosene 

{other than 1-K kerosene) you sold to qualified air carriers from 

Schedule LB in Column 1. Report gallons of other fuel you sold to 

qualified air carriers from Schedule LB in Column 2. 

Line 6c - Enter the number of UST-/EIF-free gallons of diesel 

fuel you sold to qualified ships. barges, and vessels from 

Schedule LB in Column 1. 

Lines 7 and 8 -

Column 1 - Enter the number of gallons of UST-/EIF-free 

gasoline and special fuel from Schedules C. SC. DC, 0, SD 

and DD. 

Column 2 - Enter the number of UST-/EIF-iree gallons of 

other fuels from Schedules LC and LO. 

Line 9 - This is the balancing figure on your fuel tax/fee 

accounting and should. ii al! other figures are correct. represent 

your gallonage adjustment due to temperature variation or 

evaporation. Enter any loss in Line 9a, or enter any gain in Line 

9b. 

Line 9a:The loss amount you may claim on Line 9a is 

limited. The limit is figured based on returns filed for the liability 

periods of January through June and separately for July through 

December of each year. The net loss is limited to 1 percent of 

the total gallons in storage at the beginning of each six-month 

period, plus the receipts of gallonage for each six month period. 

minus the amount of storage at the end of each six month period. 

Any loss exceeding the 1 percent limit is subject to the 

Underground Storage Tank Tax and Environmental Impact 

Fee. 

Line 10 - Add Lines 6a though 9b. Note: Line 9b is a negative field. 
Form RMFT-5-US Instructions 

Specific Instructions 

Line12-

Colurnn 1 - Enter the total number of gallons of gasoline and 

special fuel you purchased UST- and EIF-paid. 

Column 2 - Enter the total number of gallons of other fuels 

you purchased UST- and EIF-paid. 

Line 15a - The underground storage tax is 3tJ O oi a cent (.003) 

per gallon of fuel. Mulliply Line 14 by .003 and enter tl1e result. 

Line 15b -The environmental impact fee rate is $60 per 7,500 

gallons of fuel prorated to any portion. Multiply Line 14 by .008 

and enter the result. 

Line 16 - If you file your return and pay your tax and fee in full 

on time, you are allowed a collection discount. The collection 

discount is 1.75 percent (.0175) of the gross tax and lee due. 

Multiply Line 15c, gross tax and fee due. by 1.75% (.0175) and 

enter the result. 

Line 18 - If you have a credit memorandum and you wish to use it 

toward what you owe, enter the amount you are using. 

Line 1 g - Subtract Line 18 from Line 17. This is the amount you 

owe. If you do not file a processable return or pay the UST and 

EIF you owe by the due date, you will owe penalty and interest. 

We will bill you for penalties and interest. For more information, 

see Publication 103 available on our website at tax.Illinois.gov. 

Rr.1FT·5·LJS 1Ss1n,c!,ons t,ack (R-06:15) 

( 
( 

{J Illinois Department of Revenue 

RMFT-5-US-X Amended Return/Claim for Credit 

Underground Storage Tank Tax and Environmental Impact Fee 

Step 1: Identify yourself 

REV01 

ES 

HS DP CA 

Name Original reporting period_~~--/-__ _ l,1onth Year 

Address _____________________ _ 

Number and s1,eet 

Receiver license number ~R~---------

Telephone no.{ ___ } ___ - ___ _ 

City Slate ZIP 

Note: You must report your fuel in gallons. Convert liters to gallons by As originally reported Corrected 

multiplying liters by .2641721. Follow our instructions for each column. or adjusted amounts 

Column 1 Column 2 Column i Column 2 

Step 2: Figure your total gallonage for the month Gascl,ne ard Gasol,ne and 

special fuel Otl'er fuels spec,al fuel Otl'er fuels 

1 Enter your actual (stick) inventory at the beginning of the month. This 

amount must agree with closing inventory of preceding month"s return. 1 

2 Enter the number of invoiced gallons produced, acquired, received or 

transported into Illinois during the month 

a Tax/fee-free invoiced gallons (Ser A. SA,"' DA, Ccbmr 1: Sch. LA Columr 21 2a 

b Tax/Jee-paid invoiced gallons 

(Sct;edule E. SE. or LE (dyed diesel fuel). Column 1: o!her !J&ls. Sch LE. Column 2) 2b 

3 Add lines 1 through 2b and enter the result in Line 3. Remember to do 

calculations within each column. 3 

4 Enter your actual (stick) inventory at the end of t11e month. 4 

5 Subtract Line 4 from Line 3 and enter the result on Line 5. 5 

'ep 3: Figure your nontaxable gallonage 

6 Enter the number of gallons sold exempt in Illinois 

a to railroads for direct rail operation (Schejule LBJ 6a /I/I/I/Ill/!/!/!/!/ I llflll I/ !!Ill !Iii! 

b to qualified air carriers 1Sc1•edu!e U3, kernse~e. Colum" 1 utherfuels. CDlumn 21 6b 

c to qualified ships, barges, and vessels (Scl'edule LB) 6c Ii!! !If! /!if II/Ii I/ I Ill!//// Iii II !Jill 

7 Enter the number of gallons sold and delivered outside of Illinois 

!Sct1edule C. SC. DC, Column 1, SGhedule LC. Column 2) 7 

8 Enter the number of gallons sold and distributed tax!fee-free lo licensed 

receivers (Sc,,eduie D. SD. or DD. co·~nw 1, Scl1ejuie LO Colum~ 2) 8 

9 Enter the number of gallons ot your loss due io temperature variation or evaporation 

or your gain due to temperature variation. Complete Line 9a or 9b per column. 

a Loss. The amount of losses you claim are limited. See Instructions. 9a or 

b Gain. 9b ( I ( I I I I 

10 Add Lines 6a through 9b and enter the result on Line 10. 

This is your total nontaxable gallonage. 10 

Step 4: Figure your gross taxable gallonage 

11 Subtract Line 1 O from Line 5 and enter the result on Line 11. 

This is your gross taxable gallonage. 11 

Step 5: Figure your net taxable gallonage 

12 Enter the number of gallons on which tax/fee was paid at the time of purchase.12 

13 Subract Line 12 from Line 11 and enter the result on Line 13. 13 

14 Add Line 13, Column 1 and Line 13, Column 2. 

This 1s your net taxable gallonage. 14 ______ _ 

, c·s fc,r"1 ,s a~:~o, ,ed as ~o'l,oe~ vr.1ar +~ ta< er <c,e Ac, ,rcp~s,nJ to~ ,~, er fee br 1·:h·ch t•, s fo .. ~ :s f·l~d. O,sdcswe c• 11, ; •rlormal on ,s req·.J,red. 

RMFT-5-US-r. Page t <R-C-G 15) Fa 'Jre to no·,:de ,c,fonn~:,ao ma,· rosu·, 10 this fO•m nat t>e•ng procEs$ed a~1 'lla;, result ,n ~ r;;,,M'l1• 

I 
Form RMFT-5-US-X Page 2 

Step 6: Figure your tax and fee As originally reported 

or adjusted 

15 Figure your gross lax and lee due. If the amount of Line 14 is greater than zero, 

ontor tho amount from Line 14 on the line provided below and multiply by tile tax 

and lee rates provided. Otherwise, enter "ff' in Lines 1 Sa. 1 Sb, and I Sc. 

a For underground storage tank tax: X 0.003. 15a$. _____ _ 

b For environmental impact fee: ______ X 0.008. 

L·oe'4.Co: 2 

15bS _____ _ 

c Add Lines 15a and 15b. This 1s your gross tax and fee due. 15c $. ______ _ 

16 If you originally filed and paid your tax and fee due on time. figure your 

collection discount. See instructions. 16 $. ______ _ 

17 Subtract Line 16 from Line 1 Sc and enter the result on Line 17. 

This is your tax and fee due. 

Step 7: Figure the amount you owe 

18 Enter the amount of credit you wish to apply. (See instructions.) 

19 Subtract Line 18 from line 17 and enter the result on Line 19. This is 

the tax/fee due. 

17S 

18S _____ _ 

19S, _____ _ 

Corrected 

amounts 

$ 

s 

s 

s 

s 

s 

s 

20 Total amount paid to date for tl1is reporting period. 20s ______ _ 

21 Jf Corrected Amounts Column. Line 19 is greater than Line 20, 

subtract Line 20 from Line 19. This is the amount you owe. 

Make your check payable to '"Hlinois Department of Revenue.'" 

22 If Corrected Amounts Column. line 19 is less than Line 20, 

subtract Line 19 from Line 20. If you are claiming a credit, you must 

complete Step 9. 

Step 8: Sign and date your amended return 

21$ _____ _ 

22 S 

I 

Under penalties of perjury, I state that l have examined ihis return and. to the best of my knowledge. it is true, correct, and complete. ( 

Signature or pe,sor, o11'er tl1an taxpayer. v,ro prepare:J tr.is ,e1urr Dme Taxpa)'er"s rama 

Preparer's phono, rumber SogPature and 11tle ol taspayer 

Mail this return and payment to: lflinois Department of Revenue, PO Box 19019. Springfield. IL 62794-9019 

Step 9: Complete your claim for credit 

Complete Lines 23 through 25 if you are claiming a credit. 

23 Explain below why the amount for which the claim is filed is alleged to be a mistake of fact or an error in law. Attach 

additional sheets if you need more space to write in. 

24 Are you a party to any civil suits involving the above amounts? __ yes no 

If yes. what is the name of the suit? _______________ _ 

25 Sign below 

s,giature of da,:nnnt 

Title (State v,Piilher owrer. part~er. er authorized ager!) 

Dme 
I 

( 

<11 FORM 002 Illinois Department of Revenue \) ~!:,~ 10 

Sales and Use!~;,;,~,~ E911 Surcharge Return 

REV 05 

E S 

NS 

__ ./ __ 

CA RC 

rm ST-1 is due on or before the 20th day of the month following the end of the reporting period. 

You must round your figures to whole dollars. (See instructions.} 

Step 1: Alcoholic Liquor Purchases (See instructions.} Step 5: Tax on Purchases 

If you are not required to report your purchases, go to Step 2. General merchandise 

Note: 01stnbutors will also report your total purcl1ases to us. 

A Total dollar amount of alcoholic liquor purchased 

{invo:ced and del•vered) -----1--

Step 2: Taxable Receipts 

1 Total receipts (Include lax.) _____ 1 __ 

2 Deductions - include tax collected 

(From Schedule A. line 29.) 2 ______ , __ 3 Taxable receipts 

{Subtract line 2 from Line 1.) 

Step 3: Tax on Receipts 

Sales from locations within fllinois 

General merchandise 

3 

4a I x __ =4b _____ _ . 1rat,;1 Food, drugs a11d medrcal appliances 

5a x =Sb 

(W1Cl ------

Sales from locations outside Illinois 

General merchandise 

,, ------- x .0625 :::6b ------

Food, drugs and medical appliances 

I __ 

1_ 

' , __ 

12, _____ l __ x .0625 =i2b _____ 1 __ 

Food. drugs. and med,cal appliances 

13a i __ x .01 

Purchases at other rates 

14, ______ 1 __ 

15 Tax due on purcl1ases 

(Add Lines 12tl. 13b. and 14b.) 

Step 6: Net Tax Due 

16 Tax due trom receipts and purchases 

(Add Lines 11 and 15.) 

16a Manufacture(s Purchase Cred11 

(See instructions.) 

17 Prepa;d sales tax 

(Attach PST-2 copy A.) 

18 Quarter-monlhly payments 

{Paid on Form RR-3 or by EFT) 

19 Total prepayments 

(Add Lines 16a, 17. and 18.) 

20 Net tax due 

(Subtrac\ Line 19 from Lme 16.) 

=13b _____ 1 __ 

14b, _____ 1 __ 

15 ______ 1 __ 

16 1-

16, 1_ 

17 1-

18 1_ 

19 1_ 

20 1_ 

~ x .01 0 7b _____ 1__ Step 7: Payment Due 

Sales at prior rates 

Receipts taxed al other rates 

,, ' 

9 Tax due on receipts 

(Add Lines 4b, Sb, 6b, 7b. and Sb.) 

8b _____ 1 __ 

9 -----1--

Step 4: Retailer's Discount and Net Tax on Receipts 

10 II you filed and paid by the due date. 

multiply Line 9 by 1.75% (.0175). 10 J __ 

11 Net tax due on receipts 

,-~(:S:c~bt:":':'~'':":'~1~0~tc~om:'.L~ic:e~9:.}'..... __ ....'.1~1-=====:;-I--

@."""'. s~vices 

tax.illinois.gov 

Try filing electronically! 

sT .. 1 {R·09 15) 

Use this form only if a preprinted form is not available. 

Owner's name 

Business name -------------------

21 E911 Surcharge 

(From Schedule B. Line 10.) 21 -----1--

22 Excess tax and excess surcharge collected 

(See instructions.) 22 ------1--

23 Total tax and surcharge due 

(Add Lines 20, 21 and 22.) 

24 Cred11 amount 

(See instructions.) 

-+ 23 -----1--

24 _____ 1 __ 

25 Payment dlJe 

(Subtract Line 24 from Line 23.) .+ 25 I--

Step 8: Sign Below 

Under penalties of oerJury, I state !hat I have examined this return and, to the 

bes1 of my knowledge, it 1s true and correct. The intonnalio11 in this return is 

taken lrom the records of the business tor whicl1 it 1s liled. 

_!_!_ 

Taxpayer Pt,ore Date 

_!_!_ 

Prnparer Pho~e Date 

Mailing address 

( Jiness address ------------------

Write your check and send your payment to 

ILLINOIS DEPARTMENT OF REVENUE 

RETAILERS' OCCUPATION TAX 

SPRINGFIELD IL 62796-0001 

1111111111111111111111111111111!1111111111111 
Account ID: This form is for: 

Schedule A - Deductions 

j;i,.g_c;:tion 1: Taxes and miscellaneous deductions· lf no Section 1 deductions, go to Section 2. 

1 Taxes collected on general merchandise sales and service 1 

2 Taxes collected on food, drugs, and medical appliances sales and service 2 

3 E911 surcharge collected 3 

4 Resale • 4 

5 Interstate commerce o 5 

6 Manufacturing machinery and equipment (including photoprocessing) 

7 Farm machinery and equipment 

8 Graphic arts machinery and equipment (Expired August 30, 2014) 

9 Supplemental Nutrition Assistance Program (SNAP - formerly called food stamps} 

1 0 Enterprise zone 

a Sales of building materials 

b Sales oi 1iems other than building materials 

11 High impact business 

a Sales of building materials 

b Sales of items other than building materials 

12 River edge redevelopment zone building materials 

13 Exempt organizalions 

14 Sales of service - identify here ---------

15 Other (including cash refunds. newspapers and magazines. etc.) - identify below 

16 Total Section 1 deductions. Add Lines 1 through 15. 

Section 2: Motor fuel deductions - If no Section 2 deductions, go to Section 3, 

State motor fuel tax Number of gallons 

17 Gasoline 17a x 

18 Gasohol and majority blended ethanol 1 Sa x 

19 Diesel {including biodiesel and biodiesel blends) 19a x 

20 Dieselhol 20a x 

21 Other special fuels 21 a x 

Rate 

19c 

19c 

21.5C = 

2"1.5c 

19c 

• 6 

• 7 

• 8 

• 9 

., 10a 

" 10b 

.. 11a 

• 11b 

• 12 

• 13 

14 

15 

16 

17b 

1Bb 

19b 

20b 

21b 

Specific fuels sales tax exemption Receipts Percentage 

22 Gasohol 22a _____ f __ x 20% (.20) = 22b 

23 Biodiesel blend (90 - 99 percent petroleum-basej product) 23a ______ f __ x 20°··~ (.20) = 23b 

24 Biodiesel blend (1- 89 psrcen1 petroleum-based prcct~ct) 24a ______ f __ x 100% (1.00) = 24b 

25 100percentbiodiesel 25a ______ f __ x 100%(1.00)= 25b 

26 Majority blended ethanol fuel 26a ______ f __ x 100°,,o (1.00)"' 26b 

27 Otller motor fuel deductions_______________ 27 

28 Total Seciion 2 deduciions. Add Lines 17b through 26b and 27. 28 

Section 3:Total deductions 

29 Add lines 16 and 28. Write this amount on Step 2, Line 2 on the front page of this return. ..+ 29 

Schedule B - E911 Surcharge 

Receipts from retail transactions of prepaid wireless telecommunications service 

1 Enter receipts subject to E911 Surcharge. 1 

Figure your breakdown of retail transactions for .Chicago locations 

2 For Chicago locations 2a 1--' __ = 2b 

3 For Chicago locations at prior rates 3a _____ 3b j __ , __ 

4 Total E911 Surcharge for Chicago. Add Lines 2b and 3b. 

Figure your breakdown of retail transactions for non-Chicago locations 

5 For non-Chicago locations 5a j __ , __ 

6 For non-Chicago locations at prior rates 6a ______ f __ , __ 

7 Total E911 Surcharge for non-Chicago locations. Add Lines Sb and 6b. 

Figure your net E911 Surcharge 

8 Total E911 Surcharge. Add Lines 4 and 7. 

9 II you filed and paid by the due date, multiply Line 8 by 3% (.03). 

10 Subtract Line 9 from Line 8. Write this amount on Step 7, Line 21. 

4 

5b 

6b 

7 

8 

9 

~ 10 

This ta•01 1s a,.1'1cr,,cJ as ooll ~cd ucO~· th~ la< a• ice Ast ·n-μos,no 1r& tar. or •t~ •er "' ':Ch \".S •arm ,s lri<;J. D-,cb"·~ ct lti s '".,wr,m:,r, cs 

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____ f __ l _____ f __ 

_____ f __ 

_____ j __ 

_____ f __ 

______ ; __ 

_____ f __ 

_____ f __ 

_f_ 

_____ f __ 

_____ f __ 

_____ f __ 

_____ f __ 

_____ f __ 

_____ j __ 

_____ j __ 

_____ j __ 

_____ j __ 

_____ f __ 

_____ f __ 

_____ f __ 

____ f_( _____ f __ 

_____ f __ 

____ f __ 

_____ f __ 

_____ f __ 

_____ f __ 

_____ f __ 

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_____ f __ 

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----1-

ili!!illll!llll!illl!liil!llilllllllllllll 
c!J lsllin;_D

1

epartment of Revenue 

\j 1- Instructions 

General Information 

Who must file Form ST-1? 

You must file Form ST-1. Sales and Use Tax and E91 I Surcharge 

Return, if you are making retail sales of any of the following in 

Illinois: 

• general merchandise, 

• qualifying foods. drugs, and medical appliances, andlor 

• prepaid wireless telecommunications service. 

"Genera! merchandise·' includes sales of most tangible personal 

property including sales of 

• soft drinks and candy; 

• prepared food such as food purchased at a restaurant; 

• photo processing (getting pictures developed); 

• prewntten and "canned" computer software; 

• prepaid telephone calling cards and other prepaid telephone 

calling arrangements; 

• repair parts and oiher items transferred or sold in conjunction 

with providing a service under certain circumstances based 

on the actual selling price; and 

• grooming and hygiene products. 

See 86 Illinois Administrative Code regulations for a full listing of 

general merchandise. 

"Qualifying food, drugs, and medical appliances" include 

• food that has not been prepared for immediate consumption, 

( such as most food sold at grocery stores. excluding hot foods. 

alcoholic beverages. candy, and sofi drinks; 

• prescription medicines and nonprescription items claimed 

to have medicinal value, such as aspirin, cough medicine. 

and medicated hand lotlon, excluding grooming and hygiene 

products: and 

• prescription and nonprescription medical appliances that 

directly replace a malfunctioning part of the human body. 

such as corrective eyewear, contact lenses, prostheses. 

insulin syringes. and dentures. 

See 86 Illinois Adminisirative Code regulaiions for a tull l1sting of 

qualifying food, drugs, and medical appliances. 

"Prepaid wireless telecommunications service" includes sales of 

• prepaid telephone calling cards and other prepaid telephone 

calling arrangements. and 

• the minutes for ·'pay-as"you-go'" phones. 

When must I file my return? 

You must file this return, along with any payment you owe. on or 

before the 20th day of the month following the end of your reporting 

period. 

The department determines how often you must file a return based 

on your initial registration and annual liability. Filing requirements 

based on your average monthly liability are determined as follows: 

!I your average monthly liability is 

• greater than $200, the department may notify you that your 

filing frequency has been changed to a monthly requirement. 

• between $50 and $200, the department may notify you 

that your filing frequency has been changed to a quarterly 

requirement. 

ST·l lrastruct,or.s IR·OS/15) 

• less than $50, the department may notify you that 

your liling frequency has been changed to an annual 

requirement. 

Note: !f the due date falls on a weekend or holiday, your return 

and payment is due the next business day. 

Can I file this return and pay the tax due 

electronically? 

Yes. you can use My Tax Illinois on our website at 

tax.illinois.gov to file \tour Form ST-1. MyTax Illinois also 

allows for electronic payment of any tax due. 

You can also file Form ST"1 using a direct file service through 

an outside vendor. 

What if I have multiple sites? 

ll you have one business but sell items at more than one 

location (site), you must collect and remit sales and use taxes 

according to the rates of each particular location. You must 

complete and attach Form ST·2, Multiple Site Form, to your 

Form ST· 1 to show the breakdown of taxes collected and paid 

irom each site. 

My Tax Illinois allows users to calcula1e their tax due for each 

location on Form ST-2. Multiple Site Form, and combine their 

liability on a single Form ST·1. 

How can I find out what tax and surcharge rates 

I should be collecting? 

If you file electronically using MyTax Illinois, the rates will be 

populated for you according to your registration. You can also 

use the Tax Rate Database on our website at tax.illinois,gov 

to look up location specific tax rates. Oep1;;nding upon the 

location of the sale, the actual sales tax rate may be higher 

than the state rate of 6.25 percent (1.00 percent for qualifying 

food. drugs, and medical appliances} because of home rule. 

non-home rule, water commission, mass transit, park district, 

county public safety, public facilities or transportation, and 

county school facility tax. The E911 Surcharge has two different 

rates, one for Chicago locaiions and one for non-Chicago 

locations. These rates can also be found on the Tax Rate 

Database on our website. 

What if I add or discontinue one of my sites or 

change locations? 

MyTax Illinois allows users to correct, add, or delete their 

location information. You also can contact us by calling 

217 785-3707 or writing to: 

CENTRAL REGISTRATION DIVISION 

ILLINOIS DEPARTMENT OF REVENUE 

PO BOX 19030 

SPRINGFIELD IL 62794-9030 

It is important to keep your registration information updated so 

your returns will include the correct tax rates. 

What if I need help? 

II you need help, call us at 1 800 732·8866 or 217 782-3336, 

call our TDD-telecommunications device for the deaf at 

1 800 544-5304, or visit our website at tax.illinois.gov. 

Page1of6 
Specific Instructions 

When completing this form, please round to the nearest dollar by 

dropping amounts of less than 50 cents and increasing amounts of 

50 cents or more to the next higher dollar. 

Step 1: Alcoholic liquor Purchases 

line A, Total dollar amount of alcoholic liquor purchased 

(invoiced and delivered) - It you are a liquor store, tavern, or 

a restaurant that ,;;ells alcohol and you are not required to remit 

quarter-monthly payments, you must report the total dollar amount 

of all alcoholic liquor invoiced and delivered during ihe lrabiliiy 

period, regardless of when you actually remit payment to your 

distributor. By the 10th day of each month. e!;lch of \.'OUr distributors 

should give you a statement that identifies the total amount 

purchased during the previous month. This statement may be a 

summary for the month on the bottom of each of your invoices or on 

a separate report. 

Note: Liquor distributors will report to us the value of alcoholic 

beverages invoiced and delivered to eacl1 retailer the previous 

momh. 

ll you are not required to report your purchases. go to Step 2. 

Step 2: Taxable Receipts 

line 1 - Write the amount you received from all sales of 

merchandise and service. including service charges. E911 

Surcharge and taxes collected. Do not include purchases of 

merchandise on which you are paying use tax in Step 5. 

Note: You must include the county motor fuel tax imposed in 

DuPage, Kane, and McHenry counties in Line 1. 

line 2 - Write the mtal amount of deductions from Line 29 of Schedule 

A located on the back of Form ST· t. The amount of deductions on Line 

2 cannot be more than the total receipts you wrote on Line 1. If so, you 

must file a claim !or credit on Form ST-1-X. Amended Sales and Use 

Tax and E911 Surcharge Return, lor the month you originally reported 

the sale. 

Line 3 - Subtract Line 2 from Line 1. 

Step 3: Tax on Receipts 

If you report for multiple sites, you must use Form ST"2, Multiple 

Site Form. 

Sales froJTILocAtiot1s within Hlinois 

Note: If you are a multiple site retailer or service person who also has 

out-oi-state locations. see the instructions for Lines 6a and 7a. 

Line 4a • General merchandise base 

Write the portion of line 3 that you received from sales of general 

merchandise, plus the amount you received from the general 

merchandise you sold in performing your service. 

Line 4b - Multiply Line 4a by the tax rate. 

Line 5a - Food, drugs, and medical appliances base 

Write the portion of Line 3 that you received from your sales of 

qualifying food, drugs, and medical appliances, plus the amount you 

received from the qualifying food, drugs, and medical appliances you 

sold in performing your service. 

line 5b - Multiply Line Sa by the tax rate. 

ST-1 IPstrui;t1o~s (R-09115) 

SalesJ'mmiocafums outside Illinois 

Line 6a - General merchandise base ( 

Write the portion of line 3 that you received from general 

merchandise you sold to users in Illinois, plus the amount you 

received from general merchandise you sold for use in Illinois 

in performing your service. 

Line 6b - Multiply Line 6a by the tax rate. 

Line 7a ~ Food, drugs, and medical appliances base 

Write the portion of Line 3 that you received from qualifying 

food, drugs, and medical appliances you sold to users in 

Illinois, plus the amount you received from qualifying food. 

drugs, and medical appliances you sold lor use in lll1no1s 1n 

pertorming your service. 

Line 7b • Multiply Line 7a by the tax rate. 

Sal~tprior ratas 

Line Sa ~ Receipts taxed at other rates base 

Write on this line only the receipts from sales of merchandise 

and service you made at rates different from the rates printed 

in Lines 4a, 5a, 6a, and 7a. lf you need instructions on how to 

report receipts from current sales that you believe are taxable 

at a different rate, call us at one of the numbers listed in the 

"What if I need helpT section on the general information page. 

Line Sb - Multiply each amount 1n line Ba by the correct tax 

rate. add the results, and write the total on Line Sb. 

Note: Check your math. Lines 4a + 5a + 6a + 7a + Ba must 

equal Line 3. 

Line 9 · Add Lines 4b. 5b, 6b. 7b. and Sb. 

Step 4: Retailer's Discount and Net Tax on 

Receipts 

Line 1 O - II this return is electronically filed, postmarked, or 

delivered and the tax is paid by the due date, you are entitled to 

a discount. Multiply Line 9 by the percentage printed in Line 10. 

Line 11 - Subtract Line 10 from Line 9. 

Step 5: Tax on Purchases 

Note: The figures you write on Lines 12a, 13a, and 14a should 

not include amounts already contained in Lines 4a through Ba. 

Do not include tax in these Imes_ 

Line 12a - General merchandise base 

Write the sum of 

• your cost of the general merchandise you purchased to use 

from an out·of·state retailer who did not collect Illinois tax from 

you, 

• your cost of general merchandise you purchased tax free to 

sell at retail, but instead used or consumed it yourself, 

• your cost of general merchandise you purchased tax free to 

sell in performing your service, but instead used or consumed 

it yourself, or transferred subject to use tax, and 

• your cost of general merchandise an out-of-state 

serviceperson used in performing a service for you, if Illinois 

lax was not paid. 

Line 12b - Multiply Line 12a by the tax rate. 

Page2ol6 

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Line 13a - Food, drugs, and medical appliances base 

\/,/rite the sum of 

• your cost of the qual1fy1ng food, drugs, and medical appliances 

you purchased to use from an out-of-state retailer who did not 

collect Illinois tax from you, 

• your cost of the qualifying food, drugs, and medical appliances 

you purchased tax free to sell at retail, bu! instead used or 

consumed it yourself. 

• your cost of the qualifying food. drugs, and medical appliances 

you purchased tax free to sell in performing your service, but 

instead used or consumed it yourself, or transferred subject to use 

tax. and 

• your cost of the qualifying food, drugs, and medical appliances an 

out-of-state serviceperson used in petiorming a service for you, if 

Illinois tax was not paid. 

Line 13b • Multiply Line 13a by the tax rate. 

Line 14a - Purchases taxed at other rates base 

Write the total of all purchases you made at rates different from the 

rates printed in Lines 12a and 13a.This includes 

• your cost of the general merchandise and qualifying food, drugs, 

and medical appliances on which you paid tax to another state at a 

rate lower than Illinois tax rates, and 

• your cost of the general merchandise and qualifying food, drugs. 

and medical appliances an out-of-state serviceperson used in 

performing a service for you. ii Illinois tax was not paid. 

line 14b - Multiply each amount in Line 14a by the correct rate. 

add the results, and write the total on Line 14b. 

Line 15 - Add Lines 12b, 13b, and 14b. 

Step 6: Net tax due 

Line 16 -Add Lines 11 and 15. 

Line 16a • Write the total amount of Manufacturer's Purchase Credit 

(MPC) that you are using. This amount should include any MPC you 

have received from your customers plus any MPG of your own that 

you are using to satisfy use tax on qualif}1ing purchases for the current 

liability period. 

Line 17- Complete Ltre 17 only if you prepay Illinois sales tax on 

motor tuel. Write the amount ol sales tax you prepaid on motor fuel by 

adding the total from the PST-2, Prepaid Sales Tax Statement of Tax 

Paid, forms you are attaching to this return. 

Line 18 • Complete Line 18 only if you made quarter-monthly 

payments. Include on this line any prior overpayment credit that you 

used to make these payments. 

Line 19 -Add Lines 16a, 17. and 18. 

Line 20 - Subtract Line 19 from Line 16. 

ST·1 lns1ructions (R-09115) 

Step 7: Payment due 

Line 21 Write the total amount ol E911 Surcharge tram Line 10 

of Schedule B located on the back of Form ST-1. 

Line 22 • ll you collected more tax or E911 Surcharge than is 

due, write your total excess tax and excess surcharge collected. 

Line 23 - Add Lines 20, 21 and 22. 

Line 24 • If you have a credit memorandum or prior 

overpayment and you wish to use it towards what you owe, 

write the amount you are using. 

Line 25 · Subtract Line 24 from Line 23. This is the amount of 

tax and E911 Surcharge that you owe. 

Step 8: Sign below 

We cannot process this form until it is signed by the owner, 

officer, or other person authorized to sign the return. 

You owe a late-filing penalty 1f you do not file a processable 

return by the due date, a late-payment penalty ii you do not 

pay the amount you owe by the original due date of the return 

or were required to make quarter-monthly payments and 

failed to do so, a bad check penalty ii your remittance is not 

honored by your financial institution, and a cost of collection 

fee if you do not pay the amount you owe within 30 days of the 

date printed on a bill. For more information. see Publication 

103, Penalty and Interest for Illinois Taxes. available on our 

website at tax.itlinois.gov. 

We will bill you for any penalty and interest amounts owed. 

Send your return and remittance to: 

ILUNOlS DEPARTMENT OF REVENUE 

RETAILERS' OCCUPATION TAX 

SPRINGFIELD IL 62796-0001 

Page3o!6 
Schedule A Instructions 

Total deductions claimed cannot be more than the total 

receipts, including Prepaid Wireless E911 Surcharge and 

tax, on Line 1 of the ST-1 return. 

When completing this schedule, please round to the nearest dollar 

by dropping amounts of less than 50 cents and increasing amounts 

of 50 cents or more to the next higher dollar. 

line 1 • Taxes collected on general merchandise sales and 

service 

Write the amount of tax you collected on your retail sales of general 

merchandise and tax you collected on general merchandise you 

sold 1n performing service_ This includes food sold for immediate 

consumption, such as food sold at a restaurant. 

Line 2 • Taxes collected on food, drugs, and medical appliances 

sales and service 

Write the amount of tax you collected on your retail sales of 

qualifying food, drugs, and medical appliances and tax you 

collected on qualifying food, drugs. and medical appliances you 

sold in performing service. 

Line 3 - E911 Surcharge collected 

Write the amount of E911 Surcharge you collected on your retail 

sales of prepaid wireless telecommunications service. 

Line 4 - Resale 

VVrite the amount you collected from tl1e items you sold to someone 

who will resell those items at retail. For each sale for resale you 

make. the bu>•er must give you an Illinois certificate of resale or 

have a blanket certificate of resale on file with you. 

Line 5 - Interstate commerce 

Write the amount you collected from merchandise you sold that was 

shipped or delivered by you outside Illinois. 

Line 6 - Manufacturing machinery and equipment (including 

photoprocessing) 

Write the amount you collected from the sale of qualifying 

machinery and equipment (including repair and replacement parts) 

that produce iiems io be sold. 

Line 7 - Farm machinery and equipment 

Write the amount you collected from qualifying farm machinery and 

equipment (including repair and replacement parts) you sold for use 

in production agriculture. 

Line 8 - Graphic arts machinery and equipment 

Write the amount you collected from qualifying graphic arts 

machinery and equipment (including repair and replacement parts). 

Note: This exemption expired August 30, 2014. 

Line 9 - Supplemental Nutrition Assistance Program 

(SNAP - formerly called food stamps) 

Write the amount you collected from customers who used SNAP 

beneiits. 

ST-1 ln51ructions (R-09/151 

Line 1 O ~ Enterprise zone 

a) Sales of building materials ( 

Write the amount you collected from sales of building 

materials to a customer who will incorporate those materials 

into an enterprise zone certilied by the Illinois Department 

of Commerce and Economic Opportunity (DCEO). You must 

maintain in your books and records the documentation 

obtained from the customer and required by the department's 

rules to support the exemption. 

b) Sales of items other than building materials 

Write the amount you collected irom sales of items other 

than building materials to a business certified by DCEO to 

buy consumables tax free. You must maintain in your books 

and records the documentation obtained from ihe customer 

and required by the department's rules to support the 

exemption. 

This amount can include, but is not limited to: 

tangible personal property used or consumed in the 

operation of pollution control facilities. 

tangible personal property used or consumed within 

an enterprise zone 1n the process of manufacturing or 

assembly of tangible personal property tor wholesale or 

retail sale or lease. 

tangible personal property used or consumed within an 

enterprise zone in the process of graphic arts production 11 

used or consumed at a certified facility. including repair and 

replacement 

machinery and equipment used in the operation of a high ( 

impact service facility within the enterprise zone. 

jet fuel used in the operation of high impact service facilities. 

machinery and equipment used in the operation of an aircraft 

maintenance facility located within an enterprise zone. 

Line 11 - High Impact Business 

a) Sales of building materials 

Write the amount you collected from sales of building 

materials to a customer who will incorporate those materials 

into a high impact business location certified by the DCEO. 

b) Sales of items other than building materials 

Write the amount you collected from sales of items other 

than building materials to a business certified by DCEO as a 

high impact business. 

This amount can include, but is not limited to, tangible 

personal property used or consumed: 

by a high impact business in the process of manufacturing 

or assembly of tangible personal property for wholesale or 

retail sale or lease. 

by a high impact business in the process of graphic arts 

production ii used or consumed at a certified facility. 

including repair and replacement. 

Line 12 - River edge redevelopment zone building 

materials 

Write the amount you collected from sales of building materials 

to a customer who will incorporate the materials into real 

estate within a River Edge Redevelopment Zone 1n accordance ( 

with the Act by remodeling, rehabilitating, or adding new 

construction. 

Page4of6 
Line 13 • Exempt organizations 

Write the amount you collected Imm merchandise you sold to 

organizations that are exempt from paying sales tax. For each tax-

( exempt sale you make. you must obtain a copy of the organization's 

Illinois Sales Tax exemption idenlificat1on number. 

( 

Note: Do not include motor fuel taxes reported on Line 15 or 

Section 2. 

Line 14- Safes of service 

Write the total of any portion of all service transactions on which 

you did not charge your customers tax. Identify on ihe line provided 

the type of transaction that took place. Some examples of these 

are transactions made by dry cleaners, hairdressers, medical 

professionals, pharmacists, and other servicepersons. 

Line 15 • Other 

Identify other deductions. \\'rite the amount you collected from the 

sale of the deductions you listed. 

This amount can include: 

cash refunds - write the amount ol cash reiunds you made to 

customers for merchandise they returned and on which you 

have paid tax to us during the preceding return period or have 

now included on Line 1 of your Form ST-1. Note: This amount 

should not include the tax amount from 1he returned item. 

newspaper and magazine sales - write the amount you 

collected from your sales of newspapers. magazines, and other 

periodicals. 

proceeds of mandatory service charges separately stated 

on customers" bills for purchase and consumption of load 

and beverages, to the extent that the proceeds of the service 

charge are in fact turned over as tips or as a substitute for tips 

to employees who participate directly in preparing, seNing. 

hosting. or cleaning up the food or beverage function with 

respect to which the service charge is imposed. 

other deductions allowed in the Acts not listed on Lines 1 

through i4 or Section 2. 

ST·1 lnslruct,o,~s (R·09.'15) 

Line 16 -Total taxes and miscellaneous deductions 

Add the amounts on Lines i through 15, and write the total. 

Lines i 7 through 21 - State motor fuel tax 

For each type of fuel, write the number of gallons you sold. 

Multiply the number of gallons by the state tax rate printed on 

Lines 17 through 21 of Schedule A. and write the total for each 

type of fuel. 

Note: The county motor fuel tax imposed in DuPage, Kane, 

and McHenry counties must be included in the gross receipts 

on Line 1 of your return. These taxes are not authorized 

deductions from your gross receipts. Report any other local 

motor fuel taxes on Line 15. '"Other.'" Do not include ihem on 

Lines 17"21. 

Lines 22 through 27 - Speclfic fuels sales tax exemptions 

Subtract all motor fuel taxes and all state and local sales laxes 

from the amount you received for the specific fuel types listed. 

Multipi)' your receipts for each type of fuel by its corresponding 

rate on Schedule A, and write the total for each type of fuel. 

Note: On Lines 22 and 23, do not include receipts from sales 

that are not subject to sales tax. 

Line 28 - Total motor fuel deductions 

Add the amounts on Lines 17b through 26b and 27. and write 

the total. 

Line 29-Total deductions 

Add the amounts on Lines 16 and 28, and write this amount on 

Line 29 and on Step 2. Line 2 of Form ST-1. 

Note: This amount cannot exceed the amount reported on 

Line 1 of your ST-1 return. 

Page5of6 
Schedule B Instructions 

Wl1en completing this schedule, please round to the nearest dollar 

by dropping amounts of less than 50 cents and increasing amounts 

of 50 cents or more lo the next higher dollar. 

Line 1 • Write the total receipts from retail transactions of prepaid 

wireless telecommunications service. Note: Do not complete 

Schedule Bin ihe same manner that you complete Step 2 of 

Form ST-1. Instead Line 1 of Schedule B should only report your 

receipts subject to the E911 surcharge, not all amounts collected 

for the reporting penod. Do no; include receipts from sales that are 

exempt from the E911 surcharge. Also do not include the amount of 

surcharge you actually collected from your customers. 

.Ei.g_u@_j[our b@ilkdown olf(lliiil transactions for Chicago 

locations 

Locations within the city limits of Chicago are considered 

Chicago locations tor purposes of E911 Surcharge collections. 

Line 2a • Write the portion oi Line 1 receipts that were collected from 

retail transactions of prepaid wireless telecommunications service at 

Chicago locations. 

Line 2b • Multiply Line 2a by the surcharge rate of 9 percent (.09) 

for Chicago locations. 

Line 3a • Write the portion of line 1 receipts that were collected from 

retail transactions of prepaid wireless telecommunicat1ons service at 

Chicago locations at rates different from the Chicago locations included 

on Line 2a. This line will only be used if a rate change should occur and 

you are remitting E911 Surcharge for receipts that were subject to the 

rate prior to the change. 

Line 3b • Multiply line 3a by the surcharge rate. 

Note: Prior to October 1, 2014. the Prepaid Wireless E911 

Surcharge fo1· Chicago locations was 7 percent (.07). The rate 

increase bringing the E911 Surcharge rate to 9 percent for the 

city of Chicago is only effective through June 30, 2017. On July 1. 

2017. the E911 Surcharge rate for the city of Chicago is scheduled 

to revert back to 7 percent. 

Line 4 • Add Lines 2b and 3b. 

ST-1 lrs!ructions (R·09!151 

El.g_ure your breakdown of retail ti:ansactions for 

D...Qn-Chicag.9 locations ( 

Line Sa· Write the portion of L1r.e 1 receipts that were collected 

from retail transactions ol prepaid wireless telecommunications 

service at non-Chicago locations. 

Line Sb - Multiply Line Sa by the surcharge rate of 

3 percent (.03) for non-Chicago locations. 

Line 6a • Write the portion of Line 1 receipis that were collected 

from retail transactions of prepaid wireless tetecommurncati::ins 

service at non-Chicago locations at rates dlfferenl from the 

non-Chicago locations included on Line Sa. This line will only be 

used if a rate change should occur and you are remitting E911 

Surcharge for receipts that were subject to the rate prior to !he 

change. 

line 6b • Multiply Line 6a by the surcharge rate. 

Note: Prior to October I, 2015. the Prepaid Wireless E9t 1 

Surcharge for non-Chicago locations was 1.5 percent (.015). 

Line 7 • Add Lines Sb and 6b. 

Line 8 • Add Lines 4 and 7. 

line 9 • If Form ST-1 is electronically filed, postmarked, or 

delivered and the surcharge is paid by the due date, you are 

entitled to a discount. Multiply line 8 by the perceniage printed 

in Line 9. 

Line 10 • Subtract Line 9 from Line 8 and write this amount on 

Line 1 0 and on Step 7. Line 21 of Form ST-1. 

Page 6 o! ii 

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Illinois Department of Revenue 

ST-1-X Amended Sales and Use Tax and E911 Surcharge Return 

General Information 

Everyone must complete Steps 1. 2. 4. and 5. 

You must also complete Step 3 if you believe that you have overpaid. 

Step 1: Identify your business. 

1 AccountlD: _______ _ 

REV 05 FORM 003 Staiion 820, 833 

ES __ !_/ __ 

NS DP CA RC 

Do not write above thjs line. 

Amount you are paying: S _____________ _ 

Make your check payable to "Illinois Department of Revenue." 

3 Business name:--------------

2 Reportingperiodyouareamending:_ /_ I ___ througll_ ! _! _____ _ 

Mort1' Day Year r.fontl' Day Year 

Step 2: Mark the reason why you are filing an amended return. 

1 __ Overpaid (Complete Step 3) 3 __ Response to notice or bill 

2 __ Underpaid 4 __ Corrections to line items but no additional tax due 

Step 3: Mark the reason(s) why you have overpaid your return. 

If you collected the overpaid tax or E911 Surcharge from your customer(s), you must have 

unconditionaJ/y refunded the overpaid amount to your customer(s) before you file a claim for credit. 

_I am decreasing Line 1 or I am increasing Line 2 because 

I sold merchandise 

a _lo another Illinois business for resale. List the account 

ID(s) on Schedule RE and attach to Form ST-1-X. 

b _to an out-al-state customer and ii was delivered to a 

location outside Illinois. 

c _to an exempt organization. List the tax exempt (E) 

number(s) on Schedule RE and attach to Form ST-1-X. 

d _that qualifies for a tax exemption for machinery or 

equipment used in manufacturing, !arming. or graphic 

arts. (Note:The graphic arts machinery and 

equipment exemption expired August 30, 2014) 

e _ihat qualifies for an enterprise zone exemption. 

I _that was returned by my customer. 

2 _I included receipts from prior month(s} or used the wrong 

month's receipts. 

3 I failed to include tax collected in Line 2. 

4 _I used the wrong tax rate. 

Turn page to complete Steps 4 and 5. 

5 _The tax base is correct but I put it on the wrong tax line. 

6 _I made a math error calculating Lines 9,11, 15. 20, 23, or 25. 

7 _I failed to take the discount or made a math error calculating 

the discount. 

8 _I made errors completing Form ST-2. Multiple Site Form. 

9 _I am a retailer who is exchanging Manufacturer's Purchase 

Credit from a customer for cash previously paid. 

10 _I overpaid use tax because I failed to use Manufacturer's 

Purchase Credit to pa\.' use tax. 

11 _I overpaid use tax because the item 

a _qualifies for a tax exemption for machinery or equipment 

used in manufacturing, farming, or graphic arts. {Note: The 

graphic arts machinery and equipment exemption 

expired August 30, 2014) 

b _qualities for an enterprise zone exemption. 

c _was shipped to and used at a site outside Illinois. 

d _was returned to my supplier. 

lill!li 1'111111 llill ll1ll lilll l!llillll II!!llilllll 

ST-1-X (R-09115) 

Th,s 1,wn ,s aul'>urz~j as oa'l:n~Q ,wfo, !~e tax u' fe~ Act ,fl'poc,.nJ 1t-,e ,~, c, '~< b, ,ch-Ch !h:S Ferm " 'led D•solosuce cl tl1:s 

,c,for!'laMn IS ,equ.red F~,:~·e 10 prov,d~ .nbm,al :,n f"a/ ,esu•t in th:c. lo,m no< beo\3 p,ocessed Md r,,sy '"""'I :n a rena1ty. 
Step 4: Correct your financial information. 

Complete all applicable lines. 

Please round to the nearest whole dollar. 

Alcoholic Liquor Purchases 

A Total dollar amount of alcoholic liquor purchased (invoiced and delivered) 

Taxable Receipts 

1 Total receipts (Include tax.) 

2 Deductions - include tax collected (From Schedule A-X, Line 29) 

3 Taxable receipts (Subtract Line 2 from Line 1.) 

Tax on Receipts 

Sales from locations within Illinois 

4a General merchandise tax base 

4b General merchandise tax - Multiply Une 4a by your tax raie of __ _ 

Sa Food, drugs. and medical appliances tax base 

Sb Food, drugs. and medical appliances tax - Multiply Line 5a by your tax rate of __ _ 

Sales from locations outside tllinois 

Sa General merchandise tax base 

Sb General merchandise tax· Multiply Line 6a by 6.25 percent (.0625). 

7a Food. drugs, and medical appliances tax base 

7b Food, drugs. and medical appliances tax - rv1ult1ply Line 7a by 1 percent (.01). 

Sales at prior rates 

Ba Receipts at other rates tax base 

Sb Receipts at 01her rates tax - Multiply Line 8a by the appropriate tax rate ol __ _ 

9 Tax due on receipts (Add Lines 4b, 5b. 6b, 7b, and Bb.) 

Retailers' Discount and Net Tax Due on Receipts 

10 Discount (See instructions.) 

11 Net tax due on receipts (Subtract Line 10 from Lme 9.) 

Tax on Purchases 

12a General merchandise tax base 

12b General merchandise tax - Multiply Line 12a by 6.25 percent (.0625). 

13a Food, drugs. and medical appliances tax base 

13b Food. drugs. and medical appliances tax - Multiply line 13a by 1 percent (.01). 

14a Purchases at other rates tax base 

14b Purchases ai other rates tax - Multiply Line 14a by the appropriate 1ax raie of __ _ 

15 Tax due on purchases (Add Lines 12b, 13b, and 14b.) 

Net Tax Due 

16 Tax due from receipts and purchases {Add Lines 11 and 15.) 

1 Sa Manufacturer's Purchase Credit (See instructions.) 

17 Prepaid sales tax (See instructions.) 

18 Quarter-monthly payments (Paid on Form RR-3 or by EFT) 

19 Total prepayments (Add Lines 16a, 17, and 18.) 

20 t>let tax due (Subtract Line 19 from Line 16.) 

Payment Due 

21 E911 Surcharge (From Schedule 8-X. Line 10.) 

22 Excess tax and excess surcharge collected 

23 Total tax and surcharge due (Add Lines 20, 21, and 22.) 

24 Credit amount (See instructions.) 

25 Subtract Line 24 lrom Line 23. This is the net total due. 

26 Enter !he total amount you have previously paid. 

Compare Line 25, Column B. and Line 26. 

• If Line 26 is greater than Line 25, Column B. enter the difference on Line 27. 

• If Line 26 is less than Line 25, Column B, enter the difference on Line 28. 

A 

1 

2 

3 

4a 

4b 

5a 

Sb 

Ga 

6b 

7a 

7b 

Ba 

Bb 

9 

10 

11 

12a 

12b 

13a 

13b 

14a 

14b 

15 

16 

16a 

17 

18 

19 

20 

21 

22 

23 

24 

25 

Column A 

l~0s! re:er( f1~urn, t.le::J 

1_ A 

1_ 1 

1_ 2 

1- 3 

4a ____ ;_ 4b 

----1- 5a ____ 1_ 5b 

----1- Ga ___ 1_ 6b 

----1- 7a ____ 1_ 7b 

___ I_ Ba 

___ I_ Sb 

____ 1_ 9 

____ 1_ 10 ____ 1_ 11 

____ :_12a 

____ i_12b 

____ l_13a 

___ l_13b 

----1-14a 

_ ___ l_14b 

____ 1_15 

____ 1_16 ____ 1_16a ____ 1_17 

____ 1_18 ____ 1_19 

____ 1_20 

____ 1_21 

____ 1_22 

----1-23 

____ 1_24 

____ 1_25 

26 

27 Overpayment - This is the amount you have overpaid, Go to Step 5 and sign this return. 27 

28 Underpayment - This is the amount you have underpaid. Please pay this amount. Enter this amount on Page 1. 28 

Go to Step 5 and sign this return. 

Make your check payable to "lllinols Department of Revenue." 

Column B 

Figures as tl'ey sl"%11 

have teH1 f1lej 

1_1 

1_ 

I_ 

1_ 

___ 1_ 

---1-

---1-

____ 1 _ 

---1-

---1-

___ 1_ ____ 1_ 

---1-

---1-

____ 1 _ 

____ 1_ 

---1-

____ 1_ 

___ 1_ ___ 1_ ___ 1_ 

---1-{ 

___ 1_ ___ 1 _ 

____ 1_ ___ 1_ ___ 1_ 

----1-

---1-

---1-

____ 1 _ 

___ 1_ ___ 1 __ 

---L. 

--1-

___ 1_ 

___ 1_ ___ 1_ 

Step 5: Sign below. 

Under penalties of perjury, I state that I l1ave examined this return, and to the best of my knowledge, it is true, correct, and complete. Under 

penalties of perjury, I state that I have unconditionally refunded to my customer(s) any overpaid sales tax and E911 Surcharge that I collected 

from my customer(s) and am claiming as an overpayment on this return. 

Taxpayer Phone 

Mail to: lLLINOIS DEPARTMENT OF REVENUE 

PO BOX 19034 

SPRINGFIELD IL 62794-9034 

ST+X (R-09/15) 

Date Preparer Phone Dale 

lill:ltl!!ll!!!ll!lllil[liillill!lilllllillllllll 
Account ID: _______ _ 

Reporting periocl you are amending: __ .' __ ' ____ through __ /_ i __ _ MortP Day Year Monlh Day Year 

chedule A-X - Amended Deductions 

ColL1mn A 

l·,·1~s1 recent 1, urn5 hied 

ciectian 1: Taxes and miscellaneous deductianEi - If no Section 1 deductions, go ta Section 2. 

1 Taxes collected on general merchandise sales and service 1 I 

2 Taxes collected on food, drugs, and medical appliances sales and service 2 I 

3 E911 surcharge collected 3 I 

4 Resale • 4 I 

5 Interstate commerce • 5 I 

6 t,1anulacluring macl1inery and equipment (including photoprocessing) • 6 I 

7 Farm machinery and equipment • 7 I 

8 Graphic arts machinery and equipment (Expired August 30, 2014) • 8 I 

9 Supplemental Nutritron Assistance Program (SNAP· formerly called food stamps) e 9 I 

10 Enterprise zone 

a Sales of building materials 

b Sales of items other than building materials 

11 High impact business 

a Sales of building materials 

b Sales of items other than building materials 

12 River edge redevelopment zone building materials 

13 Exempt organizations 

14 Sales of service - identify here _______ _ 

15 Other (including cash refunds, newspapers and magazine, etc.)· identify below 

16 Total Section 1 deductions.Add lines 1 through 15. 

o 10a 

o10b 

o 11a 

11 11 b 

• 12 

• 13 

14 

15 1 _ 

16 

Section 2: Motor fuel deductions· If no Section 2 deductions, go to Section 3. 

State motor fuel tax 

17 Gasoline - number of gallons 

( Multiply Line 17a by 19c (:19). 

18 Gasohol and majority blended ethanol • number of gallons 

Multiply Line 18a by 19c (.19). 

19 Diesel (including biodiesel and biodiesel blends) - number of gallons 

Multiply Line 19a by 21.Sc (.215). 

20 Dieselhol • number of gallons 

Multiply Line 20a by 21.Sc (.215). 

21 Other special fuels - number of gallons 

Multiply Line 21a by 19c (.19). 

Specific_iy_ejs sales tax exemption 

22 Gasohol · total receipts 

Multiply Line 22a by 20°-o (.20). 

23 Biodiesel blend (90 - 99 percent petroleum-based product) - total receipts 

Multiply Line 23a by 20°.-;, (.20). 

24 BiodieseJ blend (1- 89 percent petroleum-based product) - total receipts 

Multiply Line 24a by 100% (1.00). 

25 100 percent biodiesel · total receipts 

Multiply Line 25a by 100% (1.00). 

26 Majority blended ethanol fuel - total receipts · 

Multiply Line 26a by 100",'o (1.00). 

27 Other motor fuel deductions. _____________ _ 

26 Total Section 2 deductions. Add lines 17b through 26b and 27. 

Section 3:Total deductions 

29 Add Lines 16 and 28. Enter these amounts on Step 4, Line 2. a+ 

17a 

17b 

18a 

18b 

19a 

19b 

20a 

20b 

21a 

21b 

22a 

22b 

23a 

23b 

24a 

24b 

25a 

25b 

26a 

26b 

27 

28 

29 

-----1--

-----1--

-----1 

-----1--· 

____ 1 __ 

____ 1 __ 

----1--

----1--

----1--

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

----1--

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

Column S 

F,;pres as li'e,' 

stio,,la lrnva been hlea 

_____ 1 __ 

____ 1 __ 

____ 1 __ 

----1--

----1--

----1--

---~-1--

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

----1--

----1--

_____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

____ 1 __ 

---1-

----1--

----1--

____ 1 __ 

____ 1 __ 

____ 1 __ 

----1--

----1--

----1--

----1--

____ 1 __ 

____ 1 __ 

____ j __ 

----1--

----1--

____ 1 __ 

____ 1 __ 

_ ___ 1 __ 

_____ 1 __ 

11111111!1111!'11111111!111!11111:lll!llll!llmlllll 

ST·1·X (R-09/15) 
Account JD· _______ _ 

Reporting period you are amending:_ ,' .' ____ throuah _ .' __ : __ _ 

M~rth Day Y<aar M;:irr1, Dsy Yea, 

Schedule B-X - Amended E911 Surcharge Column A 

M:s1 recerl 

frJJres !Ll<:d 

Column B 

f.11o~l~'~.~:/'tC:/~~{1od 

Receipts from retail transactions of prepaid wireless telecommunications service 

1 Enter receipts subject to E911 Surcharge 1 ___ , _______ , __ Figure your breakdown of retail transactions for Chicago locations 

2 For Chicago locations 2a , _______ , __ 

Multiply Line 2a by your surcharge rate of 2b ____ ,__ , __ 

3 For Chicago locations at prior rates 3a ____ ,_ 

·--'--

Multiply Line 3a by your surcharge rate of 3b ____ ,__ , __ 4 Tmal E911 Surcharge for Chicago. Add Lines 2b and 3b. 4 ____ ,__ , __ Figure your breakdown of retail transactions for non-G.hiCMQ locations 

5 For non-Chicago locations Sa _____ , _______ , __ Multiply Line 5a by your surcharge rate of Sb ____ ,__ , __ 6 For non-Chicago locations at prior rates 6a ____ ,__ , __ 

Multiply Line 6a by your surcharge 1·ate ot 6b ____ ,__ , __ 

7 Total E911 Surcharge for non-Chicago locations. Add Lines 5b and 6b. 7 ____ ,__ , __ Figure your net E911 Surcharge 

8 Total E911 Surcl1arge. Add Lines 4 and 7. 8 _____ , _______ , __ 9 If you filed and paid by the due date. multiply Lme 8 by . See instructions. 9 

10 Subtract Line 9 from Line 8. Enter these amounts on Step 4. Line 21. ~ 10 

______ , ________ , __ ______ ! ________ , __ 

( 

lillllllillilillllll!illll:llilllllllllilllll'IIIII 

ST-1-X (R-09/15) 
<J I, .ois Department of Revenue 

Schedule C 

Attach to Form RMFT-5 or Form RMFT-5-US 

~ 

MFT, UST, and EIF 

Sales and Transfers of Gasoline Products 

Delivered to Points Outside of Illinois 

Step 1: Complete the following information 

Company name 

Vour license number 

Name of state into which shipments were made 

Reporting period __ / ___ _ Month Year 

Step 2: Report your exported gallons 

1 2 3 

Invoice date Invoice Name of 

(month, day, year) number carrier 

1 __ ! _ _) ____ 

2 _ _) __ / ____ 

3 --'--'----

4 __ { __ / ____ 

5 __ ! __ ! ____ 

6 _ _) __ { ____ 

7 --'--'----

8 __ ! __ ! ____ 

9 __ { __ / ____ 

10 __ { __ / ____ 

4 

Bill of lading or 

manifest number 

5 

Name or purchaser 

11 Add the invoiced gallons in Column 8, Lines 1 through 10. Write the total amount here. 

6 

Origin 

(Illinois cities only) 

7 

Destination 

(city and state) 

12 lf you are filing only one Schedule C, write the amount form Line 11 here and on Forms RMFT-5 and RMFT-5-US, Line 7, Column 1. 

If you are filing more than one Schedule C, add Line 11 from each schedule, and write the total on Line 12 of the last page. 

Also write this amount on Forms RMFT-5 and RMFT-5-US, Line 7, Column 1. 

}~tu~'\~ ~rt~'~'.';~n~~~,;:IJ~~tl:~1lle:~?t ~~C~";[~';1iJt1,~'7or~~~~"t,~l~l~'i:~~:~·t~'N1!"~~;~;i~~~;l~~1,'tc"Jn\~~ lflforniallon IS ,c~~J~oi~:J 

RMFT-8 front (R-02100) 

Page __ of __ 

8 

Invoiced 

gallons 

11 _____ ~ 

12 _____ _ 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EJF) 

Which gasoline products must be 

reported on this schedule? 

The gasoline products that must be reported on 

this schedule are all products commonly or 

commercially known or sold as gasoline {including 

casing-head and absorption or natural gasoline), 

gasohol, motor benzol, or motor benzene, regardless of their classification or use. 

When do I file this schedule? 

You must file Schedule C in duplicate with 

Form RMFT-5 or, if you are not a licensed 

distributor, with Form RMFT-5-US. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

lf you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

RMFT-8 back (!,..Q?IOO) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

the state into which you made fuel sales or 

transfers, and the period for which you are reporting. You must prepare a separate schedule for 

each state. 

Step 2: Report your exported gallons 

Lines 1 through 10 -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 -Write the purchaser's complete name. 

Column 6 -Write the name of the Illinois city from 

which the gasoline product originated. 

Column 7 -Write the name of the city and slate 

(using the two-character U.S. Post Office abbreviation) to which the gasoline product was delivered. 

Column 8 -Write the number of invoiced gallons. 

~ 

Line 11 -Add the invoiced gallons reported in 

Column 8, Lines 1 through 10. 

Line 12 - If you are filing only one Schedule C, 

write the amount from Line 11 on Line 12 and on 

Forms RMFT-5 and RMFT-5-US, Line 7, Column 1. 

If you are filing more than one Schedule C, add 

Line 11 from each schedule, and write the total on 

Line i 2 of the last page. Also write this amount on 

Forms RMFT-5 and RMFT-5-US, Line 7, Column 1. 

t~ 
<J - Iii ... ois Department of Revenue MFT, UST, and EIF Schedule D Gasoline Products Sold and Distributed Tax- and Fee-Free 

Attach lo Form RMFT-5 or Form RMFT-5-US in Illinois to Licensed Distributors and Receivers 

Step 1: Complete the following information 

Page~_of~_ 

Company name 

Check the lax/fee type you are listing on this page. 

O MFT-free only 

Your license number 

Reporting period _ _ ! _ __ _ Month Year 

Step 2: Report your tax- and fee-free sales 

1 

Invoice date 

(month, day, year) 

1 _ _) __ / ____ 

2 _ _) __ / ____ 

3 __ ! __ , ____ 

4 _ _) __ / ____ 

5 _ _) __ / ____ 

6 _ _) _ _) ____ 

7 _ _/ __ , ____ 

8 __ , _ _) ____ 

9 __ / _ _) ____ 

10 __ CJ ____ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of purchaser 

6 

Origin 

(lllinois cities only} 

O UST-/E!F-free only 

O Both MFT- and UST-/EIF-free 

7 

Destination 

(Illinois cities only) 

8 

Purchaser's 

license number 

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 11 

12 If you are filing only one Schedule D, write the amount from Line 11 here. 12 

If you are reporting 

MFT-free gallons only, also write this amount on Form RMFT-5, Line Sa, Column 1. 

• UST- and EIF-free gallons only, also write this amount on Form RMFT-5-US, Line 8, Column 1. 

• both MFT- and UST-/ElF-free gallons, also write this amount on Forms RMFT-5, Line Sa, Column 1 and RMFT-5-US, Line 8, Column 1. 

If you are filing more than one Schedule 0, see instructions. 

RMFT-32 front (R-Q2/00) 

9 

Invoiced 

gallons 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EIF) 

Which gasoline products must be 

reported on this shedule? 

The gasoline products that must be reported on 

this schedule are all products commonly or 

commercially known or sold as gasoline (including 

casing-head and absorption or natural gasoline), 

gasohol, motor benzol, or motor benzene, regardless of their classification or use. 

When do I file this schedule? 

You must file Schedule D with Form RMFT-5 if you 

are reporiing MFT-free gallons only or both MFTand UST-/EIF-free gallons. 

You must file Schedule D with Form RMFT-5-US if 

you are reporting only UST-/EIF-free gallons. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the box next to the tax/fee type you are listing on 

this page. Report one tax/fee type only per page. 

Step 2: Report your tax- and fee-free 

sales 

Lines 1 through 10 -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the purchaser's complete name. 

Column 6 - Write the name of the Illinois city from 

which the gasoline product originated. 

Column 7 - Write the name of the Illinois city to 

which the gasoline product was delivered. 

Column 8 - Write the purchaser's IIJinois license 

number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in 

Column 9, Lines 1 through rn. 

Line 12 - If you are filing more than one Schedule 0, 

group together all Schedules D that report 

MFT-free gallons only. Add Lines 11 from this 

group, and write the total on Line 12 of the last 

page. Also write this amount on Form RMFT-5, 

Line Sa, Column 1. 

UST- and EIF-free gallons only. Add Lines 11 

from this group, and write the total on Line 12 of 

the last page. Also write this amount on 

Form RMFT-S·US, Line 8, Column 1. 

both MFT- and UST-/EIF-free gallons. Add 

Lines 11 from this group, and write the Iola! on 

Line 12 of the last page. Also write this amount 

on Form RMFT-5, Line Sa, Column 1 and 

Form RMFT-5-US, Line 8, Column 1. 

RMFT-32 back (R-02/00) 

~ 

Thes form ,s authonzed tls ou~1ned by tl1o Motor Fuol Tax Law and !ho Environmenlal ltl!pacl Fee L«w. D,sciosure or ti,,s onlormal1on is REQUIRED 

Fa,lurn lo ~tD'11de lnfurrnalmr, could result ,n a penulty. Th,s form has been npproV<!d by 1110 Forms Mar,agemenl C€nlet. IL·4B2·1 r,38 ~~ 
n ~ 

ll .>is Department of Revenue 

\J ::~o~~1~}o~oc:MFT-5-US 

Page __ of __ 

MFT, UST, and EIF 

Tax- and Fee-Paid Purchases 

Step 1: Complete the following information 

Comp,my n~me 

Check the tax/fee type you are listing on this page. 

D MFT-paid only 

Check the product type you are listing on this page. 

[ l Gasoline products 

Your license n\1mb8i-" LJ UST-IEIF-paid only I I Combustible gases 

Reporting period _ _ I _ __ _ LJ Both MFT- and UST-/EIF-paid [J Alcohol 

Montl1 Year 

Step 2: Report your tax- and fee-paid purchases 1 2 3 4 5 6 7 8 

Invoice date Name of Oripin Destina lion Seller's 

(month, Uay. year) 

Invoice 

number carrier 

Bill of lading or 

manifest number Name of seller (Illinois cilies only) , (Illinois cilies only) , license number 

1 __ I _ _ I __ __ f--------+--- -+------,------- -- ---- --

2 __ / _ _}__ -----1-------1---- -+---

3 __ / __ ,____ ----+---- -+- -- -----I4 __ / __ / ____ f-----

5 __ ! __ !____ j6 __ I . I ___ f------+------

7 _ I I ____ f--------+-----

8 --'--'---- f--------+------

9 _ _} __ / ____ 1------·· 1-------j--- c 

10 __ / __ /____ ---·--

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 

12 See instructions. 

Tl113 Fm,n ,s a,E!•1or1,:o,J ~s oullrn<l by lh>l Mntm Fuel Ta, Ulw aml Iha Env,rorimP'11al lrnpact fr" L<1·.v. D,sdOSLJW of th1•, 1nf,,rma\1rn1 •s l<fOUIHEO 

Failllm lD f)fO\'lffo rnforrM!mn co,il<J m,ult 111 " per1ally Tills r,i:rn hd'J IJeeu dpp1•1w,d by 11,~ F,mns M"''·"Jemelll c,,r,t~, IL -~q:,.ooa1 

RMFT·10 front (g-3/01) 

11 

12 

9 

lnvoice<J 

gallons 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

• Underground Storage Tank Tax (UST) 

• Environmental Impact Fee {Elf) 

Which gasoline products must be 

reported on this schedule? 

The gasoline products that must be reported on 

this schedule are all products commonly or 

commercially known or sold as gasoline (including 

casing·head and absorption or natural gasoline), 

gasohol, motor benzol, or motor benzene. regardless of their classification or use. 

When do I file this schedule? 

You must file Schedule E with Form RMFT-5 if you 

are reporting MFT-paid gallons only or MFT-, and 

UST-/EIF-paid gallons. 

You must file this schedule with Form RMFT-5-US 

if you are reporting only UST-/EIF-paid gallons. 

What records must I keep? 

You are required by law to l(eep books and records 

for at least three and one-half years showing all 

purchases, receipts, losses througl1 any cause. 

sales, distributions, and use of fuels. 

You must keep the original invoice for each tax~ 

and fee-paid purchase identified on Schedule E. 

The invoice should be receipted "paid" and initialed 

by your supplier. You are not required to attach invoices to this schedule unless we request you to 

send them in. 

If we do request your invoices to verify purchases, 

we will accept legible copies; however, we may require you send us the originals. 

RMFT· TO back' --lt) 

What if I need additional assistance? 

If you have questions about this schedule. write to 

us al Motor Fuel Tax, Illinois Department of 

Revenue, P.O. Box 19477. Springfield. Illinois 

62794-9477, or call our Springfield office weekdays between 8 a.m. and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and tile period for wllich you are reporting. Check 

the box next to the tax/fee type and the product 

type you are listing on this page. Report one lax/ 

fee type and one product type per page. 

Step 2: Report your tax- and fee-paid 

purchases 

Lines 1 through 10-

Column 1 ~ Write the rnonth, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 -Write the caiTier's complete business 

name. 

Column 4 ~ Write the bill of lading or manifest 

number. 

Column 5 -Write the seller's complete name. 

Column 6 - Write the name of the ltlinois city from 

which the gasoline product originated. 

Column 7 - Write the name of the Illinois city lo 

which the gasoline product was delivered. 

Column 8 - Write the seller's Illinois license 

number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in 

Column 9, Lines 1 through 10. 

~ 

Line 12 - !f you are filing only one Schedule E, 

write the amount from line 11 on Line 12. 

If you are reporting 

• gasoline products and 

MFT-paid on!y, also write this amount on 

Form RMFT-5, lines 2b and 17, Column 1. 

UST-/EIF-paid only, also write this amount on 

Form RMFT-5-US, Lines 2b and 12, Column 1. 

both MFT- and UST-fEIF-paid, also write this 

amount on Form RMFT-5, Lines 2b and 17, 

and Form RMFT-5-US, Lines 2b and 12, 

Column 1. 

combustible gases, alcohol, and 

.. MFT-paid only, also write this amount on 

Form RMFT-5, Line 17, Column 1. 

UST-fEIF-paid only, also write !his amount on 

Form RMFT-5-US, Line 12, Column 1 

both MFl:. and US-/E!F-paid, also write this 

amount on Form RMFT-5, Line i7, Column ·1, 

and Form RMFT-5-US. Line 12. Column 1. 

If you are filing more than one Schedule E, group 

together all Schedules E that report 

gasoline products and MFT-paid only. Cc1II 

this group "A." 

gasoline products and UST-/EIF-paid only. 

Call this group "B." 

gasoline products and both MFT- and 

UST-/E!F-paid. Call this group "C." 

• combustible gases, alcohol, and MFT-paid 

only. Call this group "D." 

• combustible gases, alcohol, and UST-/EIFpaid only. Call this group "E." 

combustible gases, alcohol, and both MFT- and 

UST-/ElF-paid. Call this group "F." 

Add Lines 11 from each group, and write the total 

amount on Line 12 of the !asl page of each group. 

Then add Line 12 from 

groups A and C, and write this amount on 

Form RMFT-5, Lines 2b and 17, Column 1. 

groups B and C, and write this amount on 

Form RMFT-5-US, Lines 2b and 12, Column 1. 

groups D and F, and write t11is amount on 

Form RMFT-5, line 17, Column 1. 

groups E and F, and write this amount on 

Form RMFT-5-US, line 12, Columr--t tl 
-

{) 

1: ois Department of Revenue MFT, uST, and EIF Page __ of __ 

Schedule DA Dyed Diesel Fuel Produced, 

Attach to Focm RMFT-5 oc Focm RMFT-5-US Acquired, Received, or Transported into Illinois 

Step 1: Complete the following information 

Company name 

Check the tax/fee type you are listing on this page. 

O MFT-free only 

Check the receipt lype you are listing on this page. 

O Dyed diesel fuel received in lllinois 

Your license number O UST-/E!F-free only 

Reporting period __ / ___ _ O Both MFT- and UST-/EIF-free 

Month Year 

Step 2: Report your tax- and fee-free purchases 

1 

Invoice date 

(month, day, year) 

1 __ , __ / ____ 

2 __ / __ ! ____ 

3 _ _) __ / ____ 

4 __ ! __ ! ____ 

5 __ ! __ ! ____ 

6 __ ! __ { ____ 

7 __ / __ / ____ 

8 --'--'----

9 __ ! __ { ____ 

10 __ , __ ! ____ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of seller 

6 

Origin 

(cily and slate) 

D Dyed diesel fuel imported into Illinois 

O Dyed diesel fuel produced in Illinois 

7 

Destination 

(Illinois cities only) 

8 

Seller's 

license number 

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 11 

9 

Invoiced 

gallons 

12 If you are filing only one Schedule DA, write the amount from Line 11 here. 12 ______ _ 

!f you are reporting 

MFT-free gallons only, also write this amount on Form RMFT-5, Line 2a, Column 3. 

• UST-/EIF-free gallons only, also write this amount on Form RMFT-5-US, Line 2a, Column 1. 

• both MFT- and UST-/EIF-free gallons. also write this amount on Form RMFT-5, Line 2a, Column 3, and Form RMFT-5-US, Line 2a, Column 1. 

If you are filing more than one Schedule DA, see instructions. "' ,>,".,C,,","m"os",",,",,,","1,eo=.=,,c,,c,,,c'"c'c•c''_"_M_M_m_,c,c•'_'"_"_'_m,-,-,-,-,,-,-,,-,-.,-,-m-.,-,,-,-,m-,-ao-,-~-.-,-,w~O-,sc-,,-,-,,-,-,,-,-,,,-m-,,-,-m-a0-,-, -.,-,-rn-,-,-ae-,-, RMFT-6-DFfronl (N-1WJ9) Failure 10 pmv1Je tt1fomrnl,on cm1IO rosult in a penalty This form hus been approved by lhe Forms M~nay~menl Cer,ter IL -492-3960 
General Instructions 

Schedule DA is used for reporting the 

following taxes: 

Motor Fuel Tax {MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EIF) 

What is dyed diesel fuel? 

Dyed diesel fuel is any special fuel that has been 

dyed per Section 4d of the Motor Fuel Tax Law. 

When do I file this schedule? 

You must file Schedule DA with Form RMFT-5, 

Motor Fuel Distributor/Supplier Tax Return, if you 

are reporting MFT-free gallons only or both MFTand UST-/EIF-free gallons. If you are a distributor 

or supplier, you must report all dyed diesel fuel 

transactions as MFT-free. 

You must file Schedule DA with Form RMFT-5-US, 

Underground Storage Tank Tax and Environmental 

Impact Fee Receiver Tax Return, if you are reporting only UST-/EIF-free gallons. 

What must I attach to this schedule? 

You must attach the credlt invoices issued by the 

seller to Schedule DA. We will return your credit invoices to you upon request. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

RMFT·6·DF t,mc'-.12/99) 

What if I need additional assistance? 

lf you have questions about this schedule, write to us 

al Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, lllinols 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 2"17 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the boxes next to the tax/fee type and the receipt 

type you are listing on this page. Report one tax/fee 

type and one receipt type only per page. 

Step 2: Report your tax- and fee-free 

purchases 

Lines 1 through 10-

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the seller's complete name. 

Column 6 - Write the city and the state (using the 

two-character U.S. Post Office abbreviation) from 

which the dyed diesel fuel product originated. 

~ 

Column 7 -Write the name of the Hlinois city to 

which the dyed diesel fuel product was delivered. 

Column 8 - Write the seller's Illinois license number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 -Add the invoiced gallons reported in 

Column 9, Lines 1 through 10. 

Line 12 - If you are filing more than one Schedule DA, group together all Schedules DA that 

report 

MFT-free only gallons. Add Lines 11 from this 

group, and write the total on Line 12 of the last 

page. 

UST-IEIF-free only gallons. Add Lines 11 from 

this group, and write the total on Line 12 of the 

last page. 

both MFT- and UST-/EIF-free gallons. Add 

Lines 11 from this group, and write the total on 

Line 12 of the last page. 

Then, add the totals from Lines 12 of the Schedules DA that report 

MFT-free gallons only group and the both 

MFT- and UST-/EIF-free gallons group and 

write this amount on Form RMFT-5, Line 2a, 

Column 3. 

UST-/EIF-free gallons only group and the both 

MFT- and UST-/EJF-free gallons group and 

write this amount on Form RMFT-5-US, Line 2a, 

Column 1. 

- t1 
~ 

\] l1i,.1ois Department of Revenue 

Schedule DD MFT, UST, and EIF 

Dyed Diesel Fuel Sold and Distributed 

Attach to Form RMFT-5 or Form RMFF-5-US Tax- and Fee-Free in Illinois to Licensed Distributors or Suppliers 

Page __ of __ 

Step 1: Complete the following information 

Company name 

Check the taxffee type you are listing on this page. 

O MFT-free only 

Your license nuinber 

Reporting period _ _ f _ __ _ Month Year 

Step 2: Report your tax- and fee-free sales and distributions 

1 

Invoice date 

(month, day, year) 

1 __ / __ / ____ 

2 __ / __ , ____ 

3 __ / __ ! ____ 

4 _ _/ __ , ____ 

5 __ / __ / ____ 

6 _ _; __ ! ____ 

7 __ , __ / ____ 

8 __ ! __ ! ____ 

9 __ , __ ! ____ 

10 __ / __ ! ____ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of purchaser 

6 

Origin 

(Illinois cities only) 

O UST-/EIF-free only 

O Both MFT- and UST-/EIF-free 

7 

Destination 

(Illinois cities only) 

8 

Purchaser's 

license number 

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 11 

9 

Invoiced 

gallons 

12 If you are filing only one Schedule 00, write the amount from Line 11 here. 12 ______ _ 

lf you are reporting 

MFT-free gallons only, also write this amount on Form RMFT-5, Line 8a, Column 3. 

, UST-/EIF-free gallons only, also write this amount on Form RMFT-5-US, Line 8, Column 1. 

• both MFT- and UST-/ElF-free gallons, also write this amount on Forms RMFT-5, Line Sa, Column 3, and RMFT-5-US, Line 8, Column 1. 

If you are filing more than one Schedule DD, see instructions. 

'' =,a-os=,e-,-m=,,-,-,,>,,-,0;..,.~d,-,-,,-,,c,,·.,c,-,=,,,-,cMcMcmc,c,c,,c,.-,c,-,w-,-,c,c,,,-,c,m-,m-,---,-,,c,c,m-,-ac","e,-,0,-,w-.=,-,mcfo-,-,,-,cMc"-'"-'"c"-'"-'c"-'°'-"-,","rn"c","ss"c"."' 

RMFT-32-0F Failure lo provide 1nforma!,on could result •n a penally. Tl11s fom1 has been appmve<J by tl1e F<,,n,s Mar,agemeotl Cenler IL-4U2.:1983 front (N-12/99) 
General Instructions 

Schedule DD is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EIF) 

What is dyed diesel fuel? 

Dyed diesel fuel is any special fuel that has been 

dyed per Section 4d of the Motor Fuel Tax Law. 

When do I file this schedule? 

You must file Schedule DD with Form RMFT-5, 

Motor Fuel Distributor/SuppllerTax Return, if you 

are reporting MFHree gallons only or both MFTand UST-/EIF-free gallons. 

You must file Schedule DD with Form RMFT-5-US, 

Underground Storage Tank Tax and Environmental 

Impact Fee Receiver Tax Return, if you are 

reporting UST-/ElF-free gallons only. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, !llinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

RMFT·32·DF b~~N-12/99) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the boxes next to the tax/fee type you are listing 

on this page. Report one tax/fee type per page. 

Step 2: Report your tax- and fee-free 

sales 

Lines 1 through 10 -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 -Write the carrier's complete business 

name. 

Column 4 -Write the bill of lading or manifest 

number. 

Column S • Write the purchaser's complete name. 

Column 6 - Write the name of the Illinois city from 

which the dyed diesel fuel product originated. 

Column 7 • Write the name of !he Illinois city to 

which the dyed diesel fuel product was delivered. 

Column 8 - Write the purchaser's Illinois license 

number. 

Column 9 - Write the number of lnvoiced gallons. 

Line 11 · Add the invoiced gallons reported in Column 9, Lines 1 through 10. 

~ 

Line 12 - If you are filing more than one Schedule DD: 

First, group together all Schedules DD that report 

UST-/EIF-free only gallons. Add Lines 11 from 

this group, and write the total on Line 12 of the 

last page. 

MFT-free only gallons. Add Lines 11 from this 

group, and write the total on Line 12 of the last 

page. 

both MFT~ and UST-fEIF-free gallons. Add 

Lines 11 from this group, and write the total on 

Line 12 of the last page. 

Then, add the totals from Lines 12 of the Schedules DD that report 

UST-fEIF-free only gallons and both MFT~ and 

UST-/EIF-free gallons and write this amount on 

Form RMFT-5-US, Line 8, Column 1. 

MFT-free only gallons and both MFT- and UST-/ 

EIF-free gallons and write this amount on Form 

RMFT-5, Line 8a, Column 3. 

t~ 
-

{) 111 .. ,ois Department of Revenue 

Schedule LA UST and EIF Page __ of __ 

Attach to Form RMFT-5-US 

Fuels Other Than Gasoline Products and Special Fuels 

Produced, Acquired, Received, or Transported into Illinois 

Step 1: Complete the following information 

Company name 

Check the receipt type you are listing on this page. 

O Other fuel products received in Illinois 

Your license number D other fuel products imported into Illinois 

Reporting period _ _ ! _ __ _ D Other fuel products produced in your Illinois refinery Month Year 

Step 2: Report your tax- and fee-free purchases 

1 2 3 4 5 6 7 B 

Invoice date Invoice Name of Bill of lading or Product Origin Destination 

(month, day, year) number carrier manifest number code Name of seller (city and slate} (lllinois cities only) 

(see instr.) 

1 __ { __ { ____ 

2 __ { __ { ____ 

3 __ { __ / ____ 

4 __ / _ _) ____ 

5 _ _/ __ ! ____ 

6 __ / _ _) ____ 

7 --'--'----

B _ _) __ / ____ 

9 _ _! _ _) ____ 

10 __ L_I ____ 

11 Add the invoiced gallons in Column 10, Lines 1 through 10. Write the total amount here. 

12 lf you are filing only one Schedule LA, write the amount from Line 11 here and on Form RMFT-5-US, Line 2a, Column 2. 

If you are filing more than one Schedule LA, add Line 11 from each schedule, and write the total on Line 12 of the last page. 

Also write this amount on Form RMFT-5-US, Line 2a, Column 2. 

RMFT-16 front (R·02/00) 

This form ,s aulhor,wd as outlined by the Motor Fuel Ta< law and Iha Env,ronmantal Impact Fee Law. D,sdosure uf this lnformaiur1 is fl.EQUIFlED 

Failure lo provtde 1nformal1on could rcsull 1n a penally Th,s form has been approved by ll,e Forms Managernant Center IL·492-2311 

9 10 

Seller's Invoiced 

license number gallons 

11 

12 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Underground Storage Tank Tax (UST) 

• Environmental Impact Fee (EIF) 

Which fuels must be reported on this 

schedule? 

The fuels that must be reported on this schedule 

include aviation fuel and 1-k kerosene. Do not 

report any type of kerosene other than 1-k kerosene on this schedule. 

When do I file this schedule? 

You must file Schedule LA with Form RMFT-5-US. 

What must I attach to this schedule? 

You must attach the credit invoices issued by the 

seller to Schedule LA. We will return your credit 

invoices to you upon request. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

If you have quesllons about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

RMFT-16 back (R-02100) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the box next to the receipt type you are listing on 

this page. Report one receipt type only per page. 

Step 2: Report your tax- and fee-free 

purchases 

Lines 1 through 10-

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the product code. 

AVI - aviation fuel 

1 K - 1-k kerosene 

OTH - other 

Column 6 - Write the seller's complete name. 

Column 7 - Write the city and state (using the 

two-character U.S. Post Office abbreviation) from 

which the fuel product originated. 

Column 8 -Write the name of the Illinois city to 

which the fuel product was delivered. 

Column 9 - Write the seller's Illinois license number. 

Column 10 - Write the number of invoiced gallons. 

-

Line 11 -Add the invoiced gallons reported in 

Column 10, Lines 1 through 10. 

Line 12 - If you are filing only one Schedule LA, 

write the amount from Line 11 on Line 12 and on 

Form RMFT-5-US, Line 2a, Column 2. If you are 

filing more than one Schedule LA, add Line 11 

from each schedule, and write the total on Line 12 

of the last page. Also write this amount on 

Form RMFT-5-US, Line 2a, Column 2. 

,') 
- n Page __ of __ s~ih;d~i;t revenue \J Attach to Form RMFT-5-US 

UST/EIF Exemption for Sales of 

Aviation Fuels, Kerosene, and Diesel Fuel 

Step 1: Complete the following information 

Company name 

Your license number 

Reporting period __ /_ _ 

Month Year 

Step 2: Report your exempt sales 

1 

lrwoice date 

(month, day, year) 

1 _ _J _ _J_ - - -

2 _ _ I __ I 

3 __ ! __ ! ____ 

4 __ ! __ ! ____ 

5 __ / __ / ____ 

6 __ , __ ! ____ 

7 __ ! __ ! ____ 

8 _.)_.) ____ 

9 _ _/ __ , ____ 

10 _.)_.) ____ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manilost numbor 

5 

Name of purchaser 

11 Add the invoiced gallons in Column 8, Lines 1 through 10. Write the total amount here. 

12 If you are tiling only one Schedule LB, write the amount from Line 11 here. If you are reporting 

• diesel fuel sold to railroads, also write this amount on Form RMFT-5-US, Line 6a, Column i. 

Check the product type you are listing on this page. 

D Diesel fuel sold to railroads 

O Diesel fuel sold to qualified ships, barges, and vessels 

D Kerosene sold to qualified air carriers 

O Aviation fuel sold to qualified air carriers 

0 1-k kerosene sold to qualified air carriers 

6 7 

Airport name Dastination 

(sales lo air carriers only), (lllinois citios only) 

8 

Invoiced 

gallons 

11 _____ _ 

• diesel fuel sold to ships, barges and vessels, also write this amount on Form RMFT-5-US, Line Be, Column 1. 

• kerosene sold to air carriers, also write this amount on Form RMFT-5-US, Line 6b, Column 1. 

• aviation fuel or 1-k kerosene sold to air carriers, also write this amount on Form RMFT-5-US, Line 6b, Column 2. 

If you are filing more than one Schedule LB, see instructions. 

RMFT-17 front (R·09/01) 

12 ______ _ 
General Instructions 

This schedule is used for reporting the 

following taxes: 

• Underground Storage Tank Tax (UST) 

• Environmental Impact Fee (EJF) 

Which fuels must be reported on this 

schedule? 

The fuels that must be reported on this schedule 

include aviation fuel, kerosene, and diesel fuel 

when the following conditions are met: 

Aviation fuel and kerosene are exempt if these 

products are for sale or use at airports with more 

than 170,000 operations per year, located in cities 

of more than 1 million inhabitants, and 

• sold to or used by holders of certificates of 

public convenience and necesssity or foreign air 

carrier permits, issued by the U.S. Department 

of Transportation, and their alr carrier affiliates, 

o, 

• received at facilities owned or leased by the 

certificate or permit holders and used in their 

activities at these airports. 

Diesel fuel is exempt if it is: 

• sold to a rail carrier registered under the Illinois 

Vehicle Code, Section 1 Bc-7201, or recognized 

by the Illinois Commerce Commission as a rail 

carrier, and used directly in railroad operations. 

• consumed or used in the operation of ships, 

barges, or vessels, all of which are used primarily in or for the transportation of property in 

interstate commerce for hire on rivers bordering 

l!inois, if the diesel fuel is delivered by a 

licensed receiver to the purchaser's barge, ship, 

or vessel while it is afloat upon a bordering 

river. 

When do I file this schedule? 

You must file this schedule with your 

Form RMFT-5-US. 

What records must I keep? 

You are required by law to keep books and records 

showing all purchases, receipts, tosses through 

any cause, sales, distributions, and use of fuels. 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, lllinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the box next to the product type you are listing on 

this page. Report one product type only per page. 

Step 2: Report your exempt sales 

Lines 1 through 1 O -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the blll of lading or manifest 

number. 

Column 5 - Write the purchaser's complete name. 

Column 6 - lf the sate was made to a qualified air 

carrier, write the name of the airport to which the 

product was delivered. 

Do not write anything in this column if the sale was 

made to a qualified rail carrier, ship, barge, or 

vessel. 

Column 7 - Write the name of the Illinois city to 

which the product was delivered. 

Column 8 - Write the amount of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in 

Column 8, Lines 1 through 10. 

Line 12 - If you are filing more than one Schedule LB, 

group together all Schedules LB that report 

• diesel fuel sold to railroads. Add Lines 11 from 

this group, and write the total on Line 12 of the 

last page. Also write this amount on 

Form RMFT-5-US, Line 6a, Column 1. 

• diesel fuel sold to qualified ships, barges, and 

vessels. Add Lines 11 from this group, and write 

the result on Line 12 of the last page. Also write 

this amount on Form RMFT-5-US, Line 6c, 

Column 1. 

• kerosene sold to qualified air carriers. Add 

lines 11 from this group, and write the total on 

Line 12 of the last page. Also write this amount 

on Form RMFT-5-US, Line 6b, Column 1. 

• aviation fuel and 1-kerosene sold to qualified air 

carrlers. Add Lines 11 from this group, and 

write the total on Line 12 of the last page. Also 

write this amount on Form RMFT-5-US, Line 6b, 

Column 2. 

RMFT-17 back (.l,U)/01) This forrn ,s aulhodzed as outl:r,ed by IM Molo, Fuel Tax law and Iha E:nv,ronmon!al Impact fee Low. o,sc!osure of tills 1nforrna11on 10 REQUIRED 

Failure lO provide mlormal,on could resull m o penalty. Thts form Ms bec........,prov~d hy lho Forms Man~gemerll Ge<\ter ll-492-2312 

- t) 
{) 1; Jis Department of Revenue u..,r and EIF Schedule LC 

Attach to Form RMFT-5-US 

Sales and Transfers of Fuels Other Than Gasoline Products 

and Special Fuels Delivered to Points Outside of Illinois 

Step 1: Complete the following information 

Page __ of __ 

Company name 

Check the product type you are listing on this page. 

D Aviation fuel 

Your license number 

0 1-k kerosene 

Name o[ slatO tiito which shipments were made 

Reporting period __ / ___ _ O Other (specify:------------

Month Year 

Step 2: Report your exported gallons 

1 2 3 

Invoice dale Invoice Name of 

(month, day, year) number carrier 

1 __ / __ , ____ 

2 _ _) __ ! ____ 

3 __ , __ ! ____ 

4 __ , __ ! ____ 

5 __ { __ ! ____ 

6 __ ! __ / ____ 

7 __ { __ / ____ 

8 __ ! __ { ____ 

9 __ { __ , ____ 

10 __ { _ _} ____ 

4 

Bill of lading or 

manifest number 

5 

Name of purchaser 

11 Add the invoiced gallons in Column 8, Lines 1 through 10. Write the total amount here. 

6 

Origin 

(Illinois cities only) 

12 lf you are filing only one Schedule LC, write the amount from Line 11 here and on Form RMFT-5-US, Line 7, Column 2. 

If you are filing more than one Schedule LC, add Line 11 from each schedule, and write the total on Line 12 of the last page. 

Also write this amount on Form RMFT-5-US, Line 7, Column 2. 

RMFT-13 front (R-02/00) 

This lorn, is aulhonzod as ouu,ned by lhc Mole>r Fuel faK Law aml the En"'romnenlal Impact Fee Law. Disclosure of l!\is rnfomial1on 1s REQUIRED. 

Failure to pruvade 111formaltot1 could result 1n a pe11alty. This form llas lleen approved lly U,e fotrns Man,iyernenl Center. ll-4S2-2:J 14 

7 

Destination 

(city and state) 

8 

Invoiced 

gallons 

--~ -,-

11 _____ _ 

12 _____ _ 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Underground Storage Tank Tax (UST) 

• Environmental Impact Fee (EIF) 

Which fuels must be reported on this 

schedule? 

The fuels that must be reported on this schedule 

include aviation fuel and 1-k kerosene. Do not 

report any type of kerosene other than 1-k kerosene on this schedule. 

When do I file this schedule? 

You must file Schedule LC in duplicate with 

Form RMFT-5-US. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sa!es, distributions, and use of 

fuels. 

What if I need additional assistance? 

!f you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, lllinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

RMFT-13 backp=•··fl2/00) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

the period for which you are reporting, and the 

state into which you made fuel sales or transfers. 

Check the box next to the product type you are 

llsting on this page. Report one state and one 

product type only per page. 

Step 2: Report your exported gallons 

Lines 1 through 1 D -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the purchaser's complete name. 

Column 6 - Write the name of the Illinois city from 

which the fuel product originated. 

Column 7 - Write the city and state {using the 

two-character U.S. Post Office abbreviation) to 

which the fuel product was delivered. 

Column 8 -Write the number of invoiced gallons. 

-

Line 11 - Add the invoiced gallons reported in 

Column 8, Lines 1 through 10. 

Line 12- lfyou are filing only one Schedule LC, 

write the amount from Line 11 on Line 12 and on 

Form RMFT-5-US, Line 7, Column 2. lfyou are 

filing more than one Schedule LC, add Line 11 

from each schedule, and write the total on Line 12 

of the last page. Also write this amount on 

Form RMFT-5-US, Line 7, Column 2. 

"' , .. 
{) lh .. 1ois Department of Revenue UST and EIF Schedule LD 

Attach to Form RMFT-5-US 

Fuels Other Than Gasoline Products and Special Fuels 

Sold Tax- and Fee-Free to Other Licensed Receivers in Illinois 

Step 1: Complete the following information 

Page __ of __ 

Company name 

Check the product type you are listing on this page. 

D Aviation fuel 

Your license number 0 1-k kerosene 

Reporting period _ _ t _ __ _ D other (specify: __________ _ Month Year 

Step 2: Report your tax- and fee-free sales 

1 2 

Invoice date Invoice 

(month, day, year) number 

1 --'--'----

2 __ / __ / ____ 

3 _ __) __ ! ____ 

4 _ _! __ ! ____ 

5 __ , __ ! ____ 

6 __ ! __ ! ____ 

7 _ _) __ / ____ 

8 _ _) _ _! ____ 

9 __ / __ , ____ 

10 __ / __ / ____ 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of purchaser 

6 

Origin 

{Illinois cities only) 

7 

Destination 

(Illinois cities only} 

11 Add the invoiced gallons in Column 9, Lines 1 through 10. Write the total amount here. 

12 !f you are filing only one Schedule LO, write the amount from Line 11 here and on Form RMFT-5-US, Line 8, Column 2. 

lf you are filing more than one Schedule LO, add Line 11 from each schedule, and write the total on Line 12 of the last page. 

Also write this amount on Form RMFT-5-US, Line 8, Column 2. 

RMFT-15 front (R-02/00) 

This form Is HUthonze<i as ouU1ned l>y tile Molor Fual T.1x Law and \ho Environmental lmract Feo Law. D,sclosum of lhis mfor!mll1on is REQUIRED 

Failure to provide information coul<i resu:! ,n a pen~lty Th,s form has been aporoved by lhe Forms Management Center. IL-492·2~15 

8 

Purchaser's 

license number 

9 

Invoiced 

gallons 

11 _____ _ 

12 _____ _ 
General Instructions 

This schedule is used for reporting the 

following taxes: 

Underground Storage Tank Tax (UST) 

• Environmental Impact Fee (E!F) 

Which fuels must be reported on this 

schedule? 

The fuels that must be reported on this schedule 

include aviation fuel and 1-k kerosene. Do not 

report any type of kerosene other than 1-k kerosene on this schedule. 

When do I file this schedule? 

You must file Schedule LO with Form RMFT-5-US. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794--9477, or 

cal! our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at217 782-2291. 

RMFT-15 back (R-02/00) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the box next to the product type you are listing on 

this page. Report one product type only per page. 

Step 2: Report your tax- and fee-free 

sales 

Lines 1 through 10 -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the purchaser's complete name. 

Column 6 -Write the name of the Illinois city from 

which the fuel product originated. 

Column 7 - Write the name of the Illinois city to 

which the fuel product was delivered. 

Column 8 - Write the purchaser's lllinois license 

number. 

Column 9 - Write the number of invoiced gallons. 

~ 

Line 11 -Add the invoiced gallons reported in 

Column 9, Lines 1 through 10. 

Line 12 - If you are filing only one Schedule LO, 

write the amount from Line 11 on Line 12 and 

write this amount on Form RMFT-5-US, Line 8, 

Column 2. If you are filing more than one Schedule LO, add Line 11 from each schedule, and write 

the total on Line 12 of the last page. Also write this 

amount on Form RMFT-5-US, Line 8, Column 2. 

- ~~ 
- \] II Jis Department of Revenue 

Schedule LE 

Attach lo Form RMFT-5-US 

US. and EIF 

Tax- and Fee-Paid Purchases of the 

Fuel Types Subject Only to UST/EIF 

Step 1: Complete the following information 

- Page ___ of __ 

Company name 

Check the product type you are listing on this page. 

r1 Aviation fuel 

--------------·······--

Your license number 

L I 1-K kerosene 

r J Dyed diesel fuel 

Reporting period __ / __ _ D Other {specify: 

Month Year 

Step 2: Report your tax- and fee-paid purchases 

1 2 3 4 5 6 7 8 

Invoice date Invoice Name of Origin Deslinat1on Seller's 

(month, day, year) number carrier 

Bill of lading or 

manifest number Name of seller (Illinois cities only) (Illinois citie$ only) license number 

1 __ ! _ _/ ____ 

2 __ / _ _I ____ \.---·---- -1-

3 __ 1 _ _1 ____ 1 -- --- ---·--1----

4 __ / __ / ----1-~-· --<----------- ----+----

5 ./ .J. _____ , __________ ,,,,1 ---1 ------

6 __ / __ / ____ C-------+-- ---+---

7 __ / __ !_ 

8 __ / __ / ____ !------+--------+-----+--------

9 / _ _/___ 1-~--

10 __ / __ / ____ ~----~------~----~-------- -··-

11 Add the invoiced gallons in Column 9, Lines 1 through iO. Write the total amount here. 

12 If you are filing only one Schedule LE, write the amount from Line 11 here and on Form RMFT-5-US, Lines 2b and 12; 

dyed diesel fuel, Column 1; other fuels, Column 2. 

!f you are filing more than one Schedule LE, add Line i 1 from each, and write the total on Line 12 of the last page. 

Also write this amount on Form RMFT-5-US, Lines 2b and 12; dyed diesel fuel, Co!unm 1; other fuels, Column 2. 

RMFT.18 front (R-3i01) 

""' "'"" ,,, """"'""''" ,,_ 0011"1"" U'f lhe li,11,,r fuel !ax L,w atld the Em1r,mm~,;i;;·l;;;1rnct f~o Law DisclosHn~ of this ,t,f,,,,,;,,i,ni, is HFOUllllii] 

F,s,lu,e to l~l_•\f_e_LflfD•n1,,1,m, '·l''"d resull_"'-'' p~r1._,l(Y_!h1~ lurrn 11~, ~en_fl'~~v~_<I ily ltw forms M,>nug~•Mnl_ CeFllF'L IL-192-2.11:1 

11 

12 

9 

Invoiced 

gallons 

---
General Instructions 

Schedule LE is used for reporting the 

following taxes: 

Underground Storage Tank Tax (UST) 

Environmental lmpact Fee (EIF) 

Which fuels must be reported on this 

schedule? 

The fuels that must be reported on !his schedule 

include aviation fuel, dyed diesel fuel, and 1-K 

kerosene. Do not report any type of kerosene other 

than 1-K kerosene on this schedule. 

What is dyed diesel fuel? 

Dyed diesel fuel is any special fuel that has been 

dyed per Section 4d of the Motor Fuel Tax Law. 

When do I file this schedule? 

You must file Schedule LE with Form RMFT-5-US. 

What records must I keep? 

You are required by law to keep books and records 

for at least three and one-half years showing all 

purchases, receipts, losses through any cause, 

sales, distributions, and use of fuels. 

You must keep the original invoice for each laxand fee-paid purchase identified on Schedule LE. 

The invoice should be receipted "paid" and inili81ed 

by your supplier. You are not required to attach invoices to this schedule unless we request you to 

send them in. 

lf we do request your invoices to verify purchases, 

we will accept legible copies; however, we may require you send us the originals. 

RMFT· 18 back ( I) 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company nalile, your license number, 

and the period for which you are reporting. Check 

the box next to the product type you are listing on 

this page. Report one product type only per page. 

Step 2: Report your tax- and fee-paid 

purchases 

Lines ·1 through 10 -

Column 1 · Write the month, day, and year of the 

invoice. 

Column 2 • Write the invoice number. 

Column 3 · Write the carrier's complete business 

name. 

Column 4 • Write the bill of lading or manifest 

number. 

Column 5 • Write the seller's complete name. 

Column 6 · Write the name of the Illinois city from 

which the fuel product originated. 

~ 

Column 7 • Write the name of the Illinois city to 

which the fuel product was delivered. 

Column 8 - Write the seller's Illinois license number. 

Column 9 • Write the number of invoiced gallons. 

Llne 11 • Add the invoiced gallons reported in 

Column 9, Lines 1 through 10. 

Line 12 • !f you are filing only one Schedule LE, 

write the amount from Line 11 on Line 12 and on 

Form RMFT-5-US, Lines 2b and 12: dyed diesel 

fuel. Colurnn 1; other fuels, Column 2. If you are 

filing more than one Schedule LE, add Line 11 

from each schedule, and write the total amount on 

Line 12 of the last page. Also write this amount on 

Form RMFT-5-US, Lines 2b and 12; dyed diesel 

fuel, Column 1; other fuels, Column 2. 

'~ 
- -

<J If Jis Department of Revenue 

Schedule SA MFT, i...:5T, and EIF 

Special Fuel (Excluding Dyed Diesel Fuel) 

Attach to Focm RMFT-5 ocFocm RMFT-5-US Produced, Acquired, Received, or Transported into Illinois 

Page __ of __ 

Step 1: Complete the following information 

Company name 

Check the tax/fee type you are listing on this page. 

D MFT-free only 

Check the receipt type that you are listing on this page. 

D Received in Illinois 

Your liconso number O UST-!EIF-free only 

Reporting period __ / ___ _ O Both MFT- and UST-/EIF-free 

Month Year 

Step 2: Report your tax- and fee-free purchases 

1 

lrwoice date 

(month, day, year} 

1 __ / _ _) ____ 

2 _ _) __ / ____ 

3 --'--'----

4 __ / __ / ____ 

5 __ / __ { ____ 

6 --'--'----

7 --'--'----

8 __ { __ / ____ 

9 __ t_J ____ 

10 __ , __ / ____ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of seller 

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 

6 

Origin 

(city and state) 

D Imported into Illinois 

D Produced in your Jllinois refinery 

7 

Deslinalion 

(Illinois cities only) 

8 

Seller's 

license number 

11 

12 Jf you are filing only one Schedule SA, write the amount from Line 11 here. 12 

lf you are reporting 

MFT-free gallons only, also write this amount on Form RMFT-5, Line 2a, Column 2. 

• UST-/EIF-free gallons only, also write this amount on Form RMFT-5-US, Line 2a, Column 1. 

• both MFT- and UST-/EIF-free gallons, also write this amount on Form RMFT-5, Line 2a, Column 2, and Form RMFT-5-US, Line 2a, Column 1. 

If you are filing more than one Schedule SA, see instructions. 

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RMF"f'.6-SF front (R-12199) FRllure \u pruv,d~ lnformali()lo could re"ull ma petmlly. Thrs rorm has been apwoved by the Fmms Management Center. IL-492-1790 

9 

Invoiced 

gallons 
General Instructions 

Schedule SA is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EIF) 

Which special fuels must be reported 

on this schedule? 

The special fuels that must be reported on this 

schedule include diesel and any other petroleum 

products (e.g., furnace oil, heating all, range oil, 

and kerosene) intended for use or offered for sa!e 

as a fuel for engines in which the fuel is injected 

into the combustion chamber and ignited by 

pressure without electrlc spark. This does not 

include 1-K kerosene or dyed diesel fuel. Report 

dyed diesel fuel on Schedule DA, Form RMFi:6-0F. 

When do I file this schedule? 

You must file Schedule SA with Form RMFT-5, 

Motor Fuel Distributor/Supplier Tax Return, if you 

are reporting MFT-free gallons only or both MFTand UST-/EIF-free gallons. 

You must file Schedule SA with Form RMFT-5-US, 

Underground Storage Tank Tax and Environmental 

Impact Fee Receiver Tax Return, if you are reporting only UST-/EIF-free gallons. 

What must I attach to this schedule? 

You must attach the credit invoices issued by the 

seller . We will return your credit invoices upon 

your request. 

RMFT-6-SF bad - 2/99) 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

lf you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, lllinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the boxes next to the tax/fee type and the receipt 

type you are listing on this page. Report one tax/fee 

type and one receipt type only per page. 

Step 2: Report your taxN and fee-free 

purchases 

Lines 1 through 10-

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

~ 

Column 5 - Write the seller's complete name. 

Column 6 -Write the clty and the state (using the 

two-character U.S. Post Office abbreviation) from 

which the special fuel product originated. 

Column 7 -Write the name of the Illinois city to 

which the special fuel product was delivered. 

Column 8 - Write the seller's Illinois license number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in Column 9, Lines 1 through 10. 

Line 12 - If you are filing more than one Schedule SA, 

First, group together all Schedules SA that report 

UST-/EIF-free only gallons. Add Lines 11 from 

this group, and write the total on Line 12 of the 

last page. 

MFT-free only gallons. Add Lines 11 from this 

group, and write the total on Line 12 of the last 

page. 

both MFT- and UST-fEIF-free gallons. Add 

Lines 11 from this group, and write the total on 

Line 12 of the last page. 

Then, add the totals from Lines 12 of the Schedules SA that report 

MFT-free only gallons and both MFT- and 

UST-fEIF-free gallons and write this amount on 

Form RMFT-5, Line 2a, Column 2. 

UST-fEIF-free only gallons and both MFT- and 

UST-fEIF-free gallons and write this amount on 

Form RMFT-5-US, Line 2a, Column 1. 

t~ 
rir 

\) ~c~o~c!R~!;',! :m ~~us 

::>is Department of Revenue -

IV1. -T, UST, and EIF 

Special Fuel (Excluding Dyed Diesel Fuel) Sold and Distributed 

Tax- and Fee-Free in Illinois to Licensed Distributors or Suppliers 

Step 1: Complete the following information 

~ 

Page ___ of~-

Company name Check the tax/fee type you are listing on this page. 

O MFT-free only 

Your license number 

Reporting period_ -'~ __ _ Month Year 

Step 2: Report your tax- and fee-free sales and distributions 

1 

Invoice date 

(month. day. year) 

1 _ _) __ , ___ _ 

2 --'--'----

3 _ _) _ _) ___ _ 

4 __ / __ / ___ _ 

5 --'--'----

6 __ ! _ _) ___ _ 

7 __ / __ / ___ _ 

8 __ / _ _) ___ _ 

9 __ / __ / ___ _ 

10 _ _) __ / ___ _ 

2 

Invoice 

number 

3 

Name of 

carrier 

4 

Bill of lading or 

manifest number 

5 

Name of purchaser 

6 

Origin 

(Illinois cities only) 

O UST-/EIF-free only 

O Both MFT- and UST-/EIF-free 

7 

Destination 

(Illinois cities only) 

8 

Purchaser's 

license number 

9 

lrwoiced 

11, 

" 

11 Add the invoiced gallons in Column 9, Lines 1 through 10, and write the total here. 11 ------~ 

12 If you are filing only one Schedule SD, write the amount from Line 11 here. 12 ______ _ 

If you are reporting 

MFT-free gallons only, also write this amount on Form RMFT-5, Line Ba, Column 2. 

• UST-/EIF-free gallons only, also write this amount on Form RMFT-5-US, Line 8, Column 1. 

• both MFT- and UST-/EIF-free gallons, also write this amount on Forms RMFT-5, Line Ba, Column 2, and RMFT-5-US, Line 8, Column 1. 

Jf you are filing more than one Sc.;h0e0

d0u0

1ec:.'ScDc,c'cece,_..in0s

0

t

0

ru0c

0

t

0

io0n0

s

0

. ________________________ _ 

Tl11s form ,s oulhorrzed as ou!lmed by Iha Motor FuolTa< Law and Ill& Envuorirnerrl"l lrnpac! Fee Law. D.sclosuro of Ulls ,.,rormHIIOtl'" REQUIRED. RMFT-32-SF Fa,1u,e to provide 1nfomoc,t1un could result m o per1ally. This form has boon approved hy jt,~ Forr,,s M~""u<lrnenl Center ll-~~2· 15~7 front (R-12/99) 
General Instructions 

Schedule SD is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (EIF) 

Which special fuels must be reported 

on this schedule? 

The special fuels that must be reported on this 

schedule include diesel and any other petroleum 

products (e.g., furnace oil, heating oil, range oil, 

and kerosene) intended for use or offered for sale as 

a fuel for engines in which the fuel is injected into 

the combustion chamber and ignited by pressure 

without electric spark. This does not include 1-K 

kerosene or dyed diesel. Report your dyed diesel 

fuel on Schedule DD, Form RMFT-32-DF. 

When do I file this schedule? 

You must file Schedule SD with Form RMFT-5, 

Motor Fuel Distrlbutor/Supp!ier Tax Return, if you 

are reporting MFT-free gallons only or both MFTand UST-/EIF-free gallons. 

You must file Schedule SD with Form RMFT-5-US, 

Underground Storage Tank Tax and Environmental 

Impact Fee Receiver Tax Return, if you are 

reporting UST-/EIF-free gallons only. 

What records must I keep? 

You are required by law to keep books and 

records showing all purchases, receipts, losses 

through any cause, sales, distributions, and use of 

fuels. 

What if I need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

cal! our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

RMFT-32·SFb< ·12199) 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number, 

and the period for which you are reporting. Check 

the boxes next to the tax/fee type you are listing 

on this page. Report one tax/fee type per page. 

Step 2: Report your tax- and fee-free 

sales 

Lines 1 through 10 -

Column 1 - Write the month, day, and year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write the carrier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 -Write the purchaser's complete name. 

Column 6 - Write the name of the Illinois city from 

which the special fuel product originated. 

Column 7 - Write the name of the Illinois city to 

which the special fuel product was delivered. 

Column 8 -Write the purchaser's lllinois license 

number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in Column 9, Lines 1 through 10. 

' 

Line 12 - If you are filing more than one 

Schedule SD: 

First, group together all Schedules SD that report 

UST-/EIF-free only gallons. Add Lines 11 from 

this group, and write the total on Line 12 of the 

last page. 

MFT-free only gallons. Add Lines 11 from this 

group, and write the total on Line 12 of the last 

page. 

both MFT- and UST-/EIF-free gallons. Add 

Lines 11 from this group, and write the total on 

Line 12 of the last page. 

Then, add the totals from Lines 12 of the all 

Schedules SD that report 

UST-/EIF-free only gallons and both MFT- and 

UST-/EIF-free gallons and write this amount on 

Form RMFT-5-US, Line 8, Column 1. 

MFT-free only gallons and both MFT- and UST-/ 

EIF-free gallons and write this amount on Form 

RMFT-5, Line 8a, Column 2. 

,') 
<J 11, .. ,ois Department of Revenue 

Schedule SE 

Attach to Form RMFT-5 or Form RMFT-5-US 

~. 

MFT, 1..JT, and EIF 

Tax- and Fee-Paid Purchases of 

Special Fuel (Excluding Dyed Diesel Fuel) 

Step 1: Complete the following information 

Page __ of __ 

Check the lax/fee type you are listing on this page. Check llie product type you are listing on this page. 

Company name [] MFT-paid only 

Your l,cenoe number r J UST-IEIF-paid only 

Reporting period I 

Monlh - y,.;,, - [-] Bolh MFT- and UST-/EIF-paid 

Step 2: Report your tax- and fee-paid purchases 1 2 3 4 

Invoice date 

(•nonl11, rJay. year) 

1 __ ! __ / ____ 

2 __ ! __ / ____ 

Invoice 

number 

Name of 

carrier 

Bill of i;:1d1ng or 

manifest number 

5 

Name of seller 

l J Special fuel (excludin[I dyed diesel fuel) 

! I 1-1< kerosene 

O Other (specify: ____ _ 

6 7 8 

Origin Destination Selle(s 

(Illinois cilies only) (Illinois cities only) license number 

3 __ { ______ I ----1------· 

4 _) __ ! ____ ----f--- -

5 _ _/ __ / __ -- ·-+ -----"""""""""" 

6 - _! _ _ / __ -- c------j----- +-- t----- !-- --- --

t -- : 

__ ; __ ; ____ t - I t 1 I9 __ I __ / ____ C---------+---------+- -----+-·----- --

10 __ / __ /____ I 

11 Add the invoiced gallons in Column 9, lines 1 through 10, and write the total here. 11 

9 

Invoiced 

gallons 

12 If you are filing only one Schedule SE, write the amount from Line 11 here. 12 ____ _ 

If you are reporting special fuel or other product type 

• MFT-paid gallons only, also write this amount on Form RMFT-5, Lines 2b and 17, Column 2. 

• UST-/EIF-paid gallons only, also write this amount on Form RMFT-5-US, Lines 2b and 12, Column 1. 

• both MFT- and UST-/EIF-paid gallons, 8lso write this amount on Form RMFT-5, Lines 2b and 17, Column 2, and Form RMFT-5-US, lines 2b and 12, Column 1. 

If you are reporting 1-K product type, write this amount on Form RMFT-5, line 17, Column 2. 

If you are filing more than one Schedule SE, see instructions. 

RMFT-10-SF fronl {R-3/01) 
General Instructions 

Schedule SE is used for reporting the 

following taxes: 

Motor Fuel Tax (MFT) 

Underground Storage Tank Tax (UST) 

Environmental Impact Fee (E!F) 

Which transactions must be reported 

on this schedule? 

You must report any fuel transactions on which 

you have paid the motor fuel tax rate for special 

fuel. UST/EIF paid gallons of 1-K kerosene must 

also be reported on Schedule LE. 

When do I file this schedule? 

You must file Schedule SE with Form RMFT-5, 

Motor Fuel Distributor/Supplier Tax Return, if you 

are reporting MFT-paid gallons only or both MFTand UST-/E!F-paid gallons. 

You must file Schedule SE with Form RMFT-5-US, 

Underground Storage Tank Tax and Environmental 

Impact Fee Receiver Tax Return, if you are reporting UST-/EIF-paid gallons on!y. 

What records must I keep? 

You are required by law to keep books and records 

for at least three and one-half years showing all 

purchases, receipts, losses through any cause, 

sales, distributions, and use of fuels. 

You must keep the original invoice for each taxand fee-paid purchase identified on Schedule SE. 

The invoice should be receipted "paid" and initialed 

by your supplier. You are not required to attach invoices to this schedule unless we request you to 

send them in. 

If we do request your invoices to verify purchases, 

we will accept legible copies; however, we may require you send us the orlginals. 

--- --·-

What if l need additional assistance? 

If you have questions about this schedule, write to us 

at Motor Fuel Tax, Illinois Department of Revenue, 

P.O. Box 19477, Springfield, Illinois 62794-9477, or 

call our Springfield office weekdays between 8 a.m. 

and 4:30 p.m. at 217 782-2291. 

Step-by-Step Instructions 

Step 1: Complete the following 

information 

Write your company name, your license number. 

and the period for which you are reporting. Check 

the box next to the tax/fee type and the product 

type you are listing on this page. Report one !ax/fee 

type and one product type per page. 

Step 2: Report your tax~ and fee~paid 

purchases 

Lines 1 through 10-

Column 1 - Write the month, day, ancl year of the 

invoice. 

Column 2 - Write the invoice number. 

Column 3 - Write !he carr·ier's complete business 

name. 

Column 4 - Write the bill of lading or manifest 

number. 

Column 5 - Write the seller's complete name. 

Column 6 - Write the name of the Illinois city from 

which the special fuel product originated. 

Column 7 - Write the name of the !11inois city to 

which the special fuel product was delivered. 

Column 8 - Write the seHer's Illinois license number. 

Column 9 - Write the number of invoiced gallons. 

Line 11 - Add the invoiced gallons reported in 

Column 9, Lines 1 through 10. 

Line 12 - If you are filing more than one Schedule SE, group together the Schedules SE that 

report product types special fuel (excluding dyed 

diesel fuel) and other by 

MFT-paid only gallons. Add Lines 11 from 

this group, and write the total on Line 12 of 

the last page. Also write this amount on 

Form RMFT-5. Line 2b, Column 2. 

UST~/EIF-paid only gallons. Add Lines 11 

from !his group, and write the total on Line 

12 of the last page. Also write this amount 

on Form RMFT-5-US, Line 2b, Column 1. 

both MFT- and UST~/EIF~paid gallons. Add 

Lines i 1 from lhls group, and write the 

total on Line 12 of the last page. Also write 

this amount on Form RMFT-5, Line 2b, 

Column 2. and Form RMFT-5-US, Line 2b, 

Colu111n 1. 

Then, group together all Schedules SE that report 

UST-/EIF~paid only gallons and both MFT- and 

UST-/EIF-paid gallons. Add the totals from Lines 

12, and write this amount on Form RMFT-5-US, 

Line 12, Column 1. Note: Do notinclude 1-K 

l(erosene in this total. 

MFT-paid only gallons and both MFT- and UST-/ 

EIF-paid gallons. Add the totals from Lines 12, 

and write this amount on Form RMFT-5, Line 17, 

Column 2. Note: Include ·1-K kerosene in this 

total. 

RMFT-10-SF be -..,_3101) 

This fnm1 is ~ull10r,~"d as ~,i11w,11>y tlLo r.io,~, FLJol fax I.aw ai,rl 111~ (.ll'!>tt>t>tMt1t,il hnpaU ~~e L.,., LJ,,,.,1"··""' ~( I'"" 1r:1<,rn1a~0n ,s HlDUIHLIJ 

r~,1,1ra lo P"'"'·IP ml"'"'"""~ n~ld_,,,,,Llll_,"_'01'""•'.!.ILT.!.'!':._l"<>I_Hl_h_.,, 1,·-p1H·~,,,11,y~·~ l,!!'""'l.''""'"I C_@IPr ll·lfl."-101:S ~~