Fill - Free fillable Form 11-C: Occupational Tax and Registration Return for (IRS) PDF form

Form 11-C

(Rev. December 2017)

Department of the Treasury

Internal Revenue Service

Occupational Tax and Registration Return for Wagering

▶

Go to www.irs.gov/Form11C for the latest information.

Return for period from

(Month and day)

(Year)

to June 30,

(Year)

OMB No. 1545-0236

Type

Name Employer identification number

Number, street, and room or suite no.

City or town, state or province, country, and ZIP or foreign postal code

Check one: First return Renewal return

Supplemental registration (Don’t complete lines 1, 2, 4, 5, or 6.)

Daytime telephone number

Business address (if different from your home address or address entered above)

Alias, style, or trade name, if any

For IRS Use Only

T $ 1

FF 2

FP 3

I 4

T $ 5

Part I Occupational Tax

1 Enter the date (month and day) you’ll start accepting wagers during the tax period . . . .

2 Tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . .

See the attached Form 11-C(V), Payment Voucher, for how to make your payments.

3 Check one:

Principal Agent accepting wagers for another (see instructions)

Part II Additional Information (for principal only)

4 If the taxpayer is a firm, partnership, or corporation, give the true name of each member or officer.

True name Title Home address Social security number

5 Are you or will you be engaged in the business of accepting wagers on your own account? . . . . .

Yes No

If “Yes,” complete a, b, and c.

a Name and address where each business is or will be conducted:

Name of location Address (number and street)

City or town, state or province, country, and ZIP or foreign postal code

Number of agents engaged in receiving wagers on your behalf

▶

c True name, address, and employer identification number of each agent:

True name Address Employer identification number

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Cat. No. 16166V

Form

11-C (Rev. 12-2017)

Form 11-C (Rev. 12-2017)

Page 2

Part III Additional Information (for agents accepting wagers on behalf of others)

6 If you receive or will be receiving wagers on behalf of, or as an agent for, some other person or persons, give the true name,

address, and employer identification number of each person.

True name Address Employer identification number

Part IV Supplemental Registration (see instructions)

Explain why you’re filing a supplemental registration. Include the date of the event.

Sign

Here

Under penalties of perjury, I declare that I’ve examined this return and/or registration (including any accompanying statements or lists), and to the best of my

knowledge and belief, it’s true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any

knowledge.

▲

Signature of officer

Date

▲

Title

Paid

Preparer

Use Only

Print/Type preparer’s name Preparer’s signature Date

Check if

self-employed

PTIN

Firm’s name

▶

Firm’s address

▶

Firm’s EIN

▶

Phone no.

Form

11-C (Rev. 12-2017)

Form 11-C (Rev. 12-2017)

Page 3

Section references are to the Internal Revenue Code

unless otherwise noted.

Future Developments

For the latest information about developments related to

Form 11-C and its instructions, such as legislation

enacted after they were published, go to www.irs.gov/

Form11C.

What’s New

Effective January 2018, send Form 11-C and/or Form

11-C(V), Payment Voucher, to Ogden UT. See Where to

file, later, for the updated address.

General Instructions

Purpose of form. Form 11-C is used to register certain

information with the IRS and to pay the occupational tax

on wagering. You must pay the occupational tax if you

accept taxable wagers for yourself or another person.

There are two amounts of occupational tax ($50 or $500).

One or the other applies depending on whether the

wagers you accept are authorized by the laws of the state

in which you accept the wager. See Line 2 later to

determine your occupational tax. Your cancelled check is

proof of registration and payment.

Who must file. File Form 11-C if you’re a principal or an

agent.

1. A principal is a person who is in the business of

accepting taxable wagers for his or her own account.

This is the person who makes a profit or risks loss

depending on the outcome of the event or contest for

which the wager is accepted.

2. An agent is a person who accepts taxable wagers

on the principal’s behalf.

Taxable wagers include those placed:

• On a sports event or contest with a person engaged in

the business of accepting wagers on a sports event or

contest.

• In a wagering pool on a sports event or contest if the

pool is conducted for profit.

• In a lottery conducted for profit (other than a state-

conducted lottery). The term lottery includes the numbers

game, policy, punch boards, and similar types of

wagering.

What isn’t taxed. The tax isn’t imposed on the following

five items.

• A parimutuel wagering enterprise, including horse

racing, dog racing, and jai alai, when licensed under the

laws of the state in which accepted.

• Coin-operated devices, such as pinball machines.

• Sweepstakes, wagering pools, or lotteries that are

conducted by an agency of a state, if the wager is placed

with the state agency or its authorized agents or

employees.

• Games of the type in which usually all persons placing

wagers in the game are present when wagers are placed,

winners are determined, and prizes or other property are

distributed.

• Drawings conducted by an organization exempt from

tax under sections 501 or 521, as long as the net

proceeds of the drawing don’t inure to the benefit of a

private shareholder or individual.

Definitions. See the Instructions for Form 730, Monthly

Tax Return for Wagers, for the definition of sports event,

contest, wagering pool, and lottery.

When to file. File the first return before wagers are

accepted. After that, file a renewal return by July 1 for

each year wagers are accepted. A first return also is due

in certain situations in which there has been a change in

ownership or control. The return must be filed within 30

days after new members are admitted to a firm or

partnership, a corporation is formed to continue the

business of a partnership, or a stockholder continues the

business of a dissolved corporation.

Employer Identification Number (EIN). Enter your EIN. If

you don’t have an EIN, apply for one online. Go to the IRS

website at www.irs.gov/EIN. You also may apply for an

EIN by faxing or mailing Form SS-4, Application for

Employer Identification Number, to the IRS.

Address. If you’re an individual, enter your home

address.

Signature. Form 11-C must be signed by a person who

has authority to sign for the taxpayer.

Where to file. Send Form 11-C, your check or money

order, and Form 11-C(V) to:

Department of the Treasury

Internal Revenue Service

Ogden, UT 84201-0101

Send the return using the U.S. Postal Service or other

designated private delivery service. See the instructions

for your income tax return for more information about

private delivery services.

Penalties. There are penalties for not filing on time, for

accepting wagers before paying the tax, and for willfully

failing to file the return. There also are penalties for

making, or helping to make, false returns, documents, or

statements.

If you receive a notice about a penalty after you file this

return, reply to the notice with an explanation and we will

determine if you meet reasonable-cause criteria. Don’t

attach an explanation when you file your return.

Disclosure of information on wagering taxes. Except

for administering or enforcing Internal Revenue taxes,

neither the Treasury Department nor any of its

employees may disclose documents, records, or

information obtained through them that a taxpayer

supplies in connection with wagering taxes. Also, certain

documents related to wagering taxes and information

obtained through them that relates to wagering taxes

won’t be used against the taxpayer in any nontax criminal

proceeding. See section 4424 for more details.

Refund. A refund for an overpayment of the occupational

tax may be claimed on Form 8849, Claim for Refund of

Excise Taxes, using Schedule 6 (Form 8849), Other

Claims. See the Instructions for Form 8849 for details.

Specific Instructions

Return period. Enter the month, day, and year the return

period begins. Also, enter the ending year. Write the year

as a four-digit number (for example, 2017 or 2018).

Form 11-C (Rev. 12-2017)

Page 4

Line 1. Enter the day and month that you will start

accepting wagers. A full month’s tax is due regardless of

which day you start accepting wagers during a month.

Line 2. Use the table below to determine the tax. The

$50 tax applies if all wagers (including those accepted by

an agent for another) are authorized under the laws of the

state in which accepted. If you intend to accept wagers

that aren’t authorized by the state, the $500 tax applies.

The tax is payable for the period that begins July 1 of

each year. If you start accepting wagers after July 31, the

tax is prorated for the first year.

Note: This tax is paid once for each period that begins

July 1. If you’re required to file a supplemental

registration, don’t pay the tax a second time.

If you start

accepting

wagers in

$500

tax

$50

tax

July . . . . . . . $500.00 . . . . $50.00

August . . . . . . 458.33 . . . . 45.83

September . . . . 416.66 . . . . 41.66

October . . . . . 375.00 . . . . 37.50

November . . . . 333.33 . . . . 33.33

December . . . . 291.66 . . . . 29.16

January . . . . . 250.00 . . . . 25.00

February . . . . . 208.33 . . . . 20.83

March . . . . . . 166.66 . . . . 16.66

April . . . . . . . 125.00 . . . . 12.50

May . . . . . . . 83.33 . . . . 8.33

June . . . . . . 41.66 . . . . 4.16

Payment voucher. Complete Form 11-C(V), Payment

Voucher, and file it with Form 11-C and your payment.

Line 3. You must check one of the boxes. See Who must

file, earlier, for the definition of principal and agent.

Principals are liable for the excise tax on wagers, which is

reported and filed monthly on Form 730.

Lines 4 and 5. These lines are to be completed by

principals only. Enter applicable information for officers

and/or partners of the company on line 4. Enter on line

5a the name and address of each location where

business will be conducted. Enter the number of agents

who accept wagers for you on line 5b and their names,

addresses, and EINs on line 5c.

Line 6. This line is to be completed by agents accepting

wagers on behalf of another. Enter the name, address,

and EIN of each person or company on whose behalf you

accept wagers.

Supplemental Registration

Line 7. If you, as a principal, change your home or

business address, you must file a supplemental

registration before accepting wagers at the new address

or by the end of the 30-day period after the change,

whichever occurs first. If you engage a new agent to

receive wagers, you must file, within 10 days of engaging

the agent, a supplemental registration reporting the

agent’s name, address, and EIN.

You must file a supplemental registration within 30

days of the occurrence of any of the following events.

• As the surviving spouse or child, executor,

administrator, or other legal representative, you continue

for the remainder of the period the business of a

deceased person who paid the occupational tax.

• As a receiver, trustee in bankruptcy, or assignee for

creditors, you continue the business for the remainder of

the period.

• There is a change of members of a partnership which is

a principal.

• There is a name change of a corporation which is a

principal.

Agents. You must complete line 7 if you have

previously filed Form 11-C and are engaged to receive

wagers for another. You must register the name,

address, and EIN of each new person who engaged you

within 10 days after being engaged.

How to file a supplemental registration. Complete the

name, address, EIN, business address, and alias lines.

• Check the “supplemental registration” box.

• Check the applicable box on line 3 and enter the

information that has changed on line 7, including the date

of the event of change.

• Don’t complete lines 1, 2, 4, 5, or 6 for a supplemental

registration.

Paid Preparer Use Only

A paid preparer must sign Form 11-C and provide the

information in the Paid Preparer Use Only section at the

end of the form if the preparer was paid to prepare the

form and isn’t an employee of the filing entity. The

preparer must give you a copy of the form in addition to

the copy to be filed with the IRS. If you’re a paid preparer,

enter your Preparer Tax Identification Number (PTIN) in

the space provided. Include your complete address. If

you work for a firm, you also must enter the firm’s name

and the EIN of the firm. However, you can’t use the PTIN

of the tax preparation firm in place of your PTIN. You can

apply for a PTIN online or by filing Form W-12, IRS Paid

Preparer Tax Identification Number (PTIN) Application and

Renewal. For more information about applying for a PTIN

online, visit the IRS website at www.irs.gov/PTIN.

Form 11-C (Rev. 12-2017)

Page 5

Privacy Act and Paperwork Reduction

Act Notice

We ask for the information on Form 11-C to carry out the

Internal Revenue laws of the United States. You’re

required to give us the information. We need it to ensure

that you’re complying with these laws and to allow us to

figure and collect the right amount of tax. Section 4411

imposes a special tax on each person who is engaged in

receiving wagers for or on behalf of any person liable for

the tax on wagers. Section 4412 requires that person to

amount of the tax you owe and to register certain

information with the IRS. Section 6109 requires you to

provide your identification number. Unless specifically

prohibited by law, routine uses of this information include

giving it to the Department of Justice for civil and criminal

litigation; to cities, states, the District of Columbia, and

U.S. commonwealths and possessions for use in

administering their tax laws; to other countries under a

tax treaty; to federal and state agencies to enforce federal

nontax criminal laws; or to federal law enforcement and

intelligence agencies to combat terrorism. If you fail to

provide this information in a timely manner, you may be

subject to penalties.

You aren't required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its

instructions must be retained as long as their contents

may become material in the administration of any Internal

Revenue law. Generally, tax returns and return

information are confidential, as required by section 6103.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

burden for this form is: Recordkeeping, 3 hr., 49 min.;

Learning about the law or the form, 57 min.; Preparing

the form, 2 hr., 0 min.; and Copying, assembling, and

sending the form to the IRS, 16 min.

If you have comments concerning the accuracy of

these time estimates or suggestions for making this form

simpler, we’d be happy to hear from you. You can send

us comments from www.irs.gov/FormComments. Or you

can write to:

Internal Revenue Service

Tax Forms and Publications

1111 Constitution Ave. NW, IR-6526

Washington, DC 20224

Don’t send the form to this address. Instead, see

Where to file, earlier.

Form 11-C(V),

Payment Voucher

Purpose of Form

Complete Form 11-C(V), Payment Voucher, and file it

with Form 11-C, Occupational Tax and Registration

Return for Wagering. We will use Form 11-C(V) to credit

your payment more promptly and accurately, and to

improve our service to you.

If you have your return prepared by a third party,

provide Form 11-C(V) to the return preparer.

Specific Instructions

Box 1. If you don’t have an EIN, apply for one online. Go

to the IRS website at www.irs.gov/EIN. You also may

apply for an EIN by faxing or mailing Form SS-4,

Application for Employer Identification Number, to the

IRS.

Box 2. Enter the amount paid with Form 11-C.

Box 3. Enter the same year and month you entered on

the “Return for period from” line at the top of Form 11-C.

For example, if your return is for the full period that begins

July 1, 2017, enter 201707.

Box 4. Enter your name and address as shown on Form

11-C.

• Enclose your check or money order made payable to

“United States Treasury.” Be sure to enter your EIN,

“Form 11-C,” and the tax period on your check or money

order. Don’t send cash. Don’t staple Form 11-C(V) or your

payment to Form 11-C (or to each other).

• Detach Form 11-C(V) and send it with your payment

and Form 11-C. See Where to file, earlier.

▼

Detach Here and Mail With Your Payment and Form 11-C.

▼

Form

11-C(V)

(Rev. December 2017)

Department of the Treasury

Internal Revenue Service

Payment Voucher

▶

Don’t staple or attach this voucher to your payment or Form 11-C.

OMB No. 1545-0236

1 Enter your employer identification

number.

Enter the amount of your payment.

▶

Make your check or money order payable to “United States Treasury”

Dollars Cents

Enter year and month as shown on Form 11-C.

Y Y M M

Send Form 11-C, this voucher, and payment to:

Department of the Treasury

Internal Revenue Service

Ogden, UT 84201-0101

4 Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city or town, state or province, country, and ZIP or foreign postal code.

Fill Online, Printable, Fillable, Blank Form 11-C: Occupational Tax and Registration Return for (IRS) Form

Use our library of forms to quickly fill and sign your IRS forms online.

Related forms

Fillable Form 11-C: Occupational Tax and Registration Return for (IRS)

Fill Online, Printable, Fillable, Blank Form 11-C: Occupational Tax and Registration Return for (IRS) Form

Use our library of forms to quickly fill and sign your IRS forms online.

Related forms

First 20 documents completely FREE!