CITY OF JOHNSTON CITY
MONTHLY MOTOR FUEL TAX RETURN
Effective __________________
Month/Year Due Date:
of Collection: ___________________________ The 20th day of the following Month
Payee Name (Corporate/Company): Local Business Name (DBA):
_________________________________ ________________________________
Mailing Address: Business Location Address:
_________________________________ _________________________________
_________________________________ _________________________________
_________________________________ _________________________________
_________________________________
Phone: ___________________ Phone: ___________________
Illinois Business Tax (IBT) Number for
Local Business Location (from Form ST-1 and CMFT-1l/CMFT-2): _______________________
COMPUTATION OF TAX LIABILITY
1. Gallons of Motor Fuel Sold ______________________
2. Johnston City Motor Fuel Tax (line 1 X $0.02) $_______________
3. Interest and Penalties (if paid after the due date): ______________________
Interest Charges 1.0% per month Late Filing Penalty
5% of the amount of tax due Late Payment Charges
5% of the amount of tax due $________________
4. Total Tax, Interest and Penalties Due (Add Lines 2 and 3) $________________
Under penalties of perjury and other penalties provided by law, I declare that I have examined this return and to the best of my knowledge and belief it is true, correct and complete. I further declare that the information set forth is taken from the books and records of the business for which this return is filed
_____________________________________ ______________________________
Signature of Preparer Date Signature of Taxpayer Date
Please mail this completed return, a check in the amount shown on line 4, and a copy of:
Illinois Department of Revenue Form ST-1 (Sales and Use Tax Return).
County Motor Fuel Tax Form CMFT-l/CMFT-2
City of Johnston City
100 West Broadway Blvd.
Johnston City, IL 62951 Phone: 618-983-6651
Attn: City Clerk, Motor Fuel Tax Fax: 618-983-3325
(Ord. 12-11, passed 7-31-2011)