Fillable Form 720: Quarterly Federal Excise Tax Return (IRS)

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Form 720: Quarterly Federal Excise Tax Return (IRS)

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Form
720
(Rev. April 2013)
Department of the Treasury
Internal Revenue Service
Quarterly Federal Excise Tax Return
▶
See the Instructions for Form 720.
▶
Information about Form 720 and its separate instructions is at www.irs.gov/form720.
OMB No. 1545-0023
Check here if:
Final return
Address change
Name Quarter ending
Number, street, and room or suite no.
(If you have a P.O. box, see the instructions.)
Employer identification number
City, state, and ZIP code. (If you have a foreign address, see the instructions.)
FOR IRS USE ONLY
T
FF
FD
FP
I
T
Part I
IRS No.
Environmental Taxes (attach Form 6627)
Tax
IRS No.
18 Domestic petroleum oil spill tax 18
21 Imported petroleum products oil spill tax
21
98 Ozone-depleting chemicals (ODCs)
98
19 ODC tax on imported products
19
Communications and Air Transportation Taxes (see instructions)
Tax
22 Local telephone service and teletypewriter exchange service 22
26 Transportation of persons by air
26
28 Transportation of property by air
28
27 Use of international air travel facilities 27
Fuel Taxes
Number of gallons Rate
Tax
(a) Diesel, tax on removal at terminal rack
60
(b)
Diesel, tax on taxable events other than removal at terminal rack
(c) Diesel, tax on sale or removal of biodiesel mixture
other than removal at terminal rack
60
104 Diesel-water fuel emulsion 104
105 Dyed diesel, LUST tax
105
107 Dyed kerosene, LUST tax
107
119 LUST tax, other exempt removals (see instructions)
119
35
(a)
Kerosene, tax on removal at terminal rack (see instructions)
(b)
Kerosene, tax on taxable events other than removal at terminal rack
35
69 Kerosene for use in aviation (see instructions)
69
77
Kerosene for use in commercial aviation (other than foreign trade)
77
111 Kerosene for use in aviation, LUST tax on nontaxable uses 111
79 Other fuels (see instructions)
79
(a) Gasoline, tax on removal at terminal rack
62
(b)
Gasoline, tax on taxable events other than removal at terminal rack
62
13 Any liquid fuel used in a fractional ownership program aircraft
13
14 Aviation gasoline
14
112 Liquefied petroleum gas (LPG)
112
118 “P Series” fuels 118
120 Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)
120
121 Liquefied hydrogen
121
122 Fischer-Tropsch process liquid fuel from coal (including peat)
122
123 Liquid fuel derived from biomass
123
124 Liquefied natural gas (LNG)
124
}
}
}
33
Retail Tax—Truck, trailer, and semitrailer chassis and bodies, and tractors
33
Ship Passenger Tax
Number of persons Rate Tax
29 Transportation by water
29
Other Excise Tax
Amount of obligations
Rate Tax
31 Obligations not in registered form
31
Foreign Insurance Taxes— Policies issued by foreign insurers
Premiums paid Rate
Tax
IRS No.
Casualty insurance and indemnity bonds
30
Life insurance, sickness and accident policies, and annuity contracts
Reinsurance
30
}
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10175Y
Form
720 (Rev. 4-2013)
$.244
.244
.244
.198
.001
.001
.001
.244
.244
.219
.044
.001
.184
.184
.141
.194
.183
.184
.183
.184
.244
.244
.243
12% of sales price
$3 per person
$ .01
$ .04
.01
.01
Form 720 (Rev. 4-2013)
Page 2
IRS No.
Manufacturers Taxes
Number of tons Sales price Rate Tax IRS No.
36
Coal—Underground mined
36
37 37
38
Coal—Surface mined
38
39 39
Number of tires
Tax
IRS No.
108
Taxable tires other than bias ply or super single tires
108
109
Taxable bias ply or super single tires (other than super single tires designed for steering)
109
113 Taxable tires, super single tires designed for steering
113
40 Gas guzzler tax. Attach Form 6197. Check if one-time filing . . . . . . .
. . . . .
40
97 Vaccines (see instructions)
97
Sales price
2.3% of sales price
136 Taxable medical devices
136
1
Total. Add all amounts in Part I. Complete Schedule A unless one-time filing
▶
$
Part II
IRS No.
Patient-Centered Outcomes Research Fee (see
instructions)
(a) Avg. number
of lives covered
(b) Rate for avg.
covered life
Col. (a) x Col. (b)
Tax
IRS No.
133
Specified health insurance policies
}
133
Applicable self-insured health plans
Rate
41
Sport fishing equipment (other than fishing rods and fishing poles)
41
110 Fishing rods and fishing poles (limits apply, see instructions)
110
42 Electric outboard motors
42
114 Fishing tackle boxes
114
44 Bows, quivers, broadheads, and points
44
106 Arrow shafts 106
140 Indoor tanning services 140
Number of gallons Rate Tax
64 Inland waterways fuel use tax
64
125 LUST tax on inland waterways fuel use (see instructions)
125
51
Alcohol and cellulosic biofuel sold as but not used as fuel
51
117 Biodiesel sold as but not used as fuel 117
20
Floor Stocks Tax— Ozone-depleting chemicals (floor stocks). Attach Form 6627.
20
2 Total. Add all amounts in Part II
▶
$
Part III
3 Total tax. Add Part I, line 1, and Part II, line 2 . . . . . . . . . . . . . . . . .
▶
3
4 Claims (see instructions; complete Schedule C) . . . . . . .
▶
4
5 Deposits made for the quarter . . . .
▶
5
Check here if you used the safe harbor rule to make your deposits.
6 Overpayment from previous quarters . .
▶
6
7
Enter the amount from Form 720X included
on line 6, if any . . . . . . . . .
▶
7
8 Add lines 5 and 6 . . . . . . . . . . . . . . . . .
▶
8
9 Add lines 4 and 8 . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
9
10
Balance Due. If line 3 is greater than line 9, enter the difference. Pay the full amount with the return (see instructions)
▶
10
11 Overpayment. If line 9 is greater than line 3, enter the difference. Check if you want the
overpayment:
Applied to your next return, or Refunded to you.
11
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No
Designee name
▶
Phone no.
▶
Personal identification number (PIN)
▶
Sign
Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
▲
Signature Date
▲
Title
Type or print name below signature.
▶
Telephone number
▶
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 720 (Rev. 4-2013)
$1.10 per ton
4.4% of sales price
$ .55 per ton
4.4% of sales price
$1.00
$1.00
10% of sales price
10% of sales price
3% of sales price
3% of sales price
11% of sales price
$ .48 per shaft
10% of amount paid
$ .20
.001
Form 720 (Rev. 4-2013)
Page
3
Schedule A
Excise Tax Liability (see instructions)
Note. You must complete Schedule A if you have a liability for any tax in Part I of Form 720. Do not complete Schedule A for
Part II taxes or for a one-time filing of the gas guzzler tax.
1
Regular method taxes
(a)
Record of Net
Tax Liability
Period
1st–15th day 16th–last day
First month A B
Second month C D
Third month E F
Special rule for September
* . . . . . . . . .
▶
G
(b) Net liability for regular method taxes. Add the amounts for each semimonthly period.
2
Alternative method taxes (IRS Nos. 22, 26, 28, and 27)
(a)
Record of Taxes
Considered as
Collected
Period
1st–15th day 16th–last day
First month M N
Second month O P
Third month Q R
Special rule for September
*
. . . . . . . . .
▶
S
(b) Alternative method taxes. Add the amounts for each semimonthly period.
*Complete only as instructed (see instructions).
Schedule T
Two-Party Exchange Information Reporting (see instructions)
Fuel
Number of gallons
Diesel fuel, gallons received in a two-party exchange within a terminal, included
on IRS No. 60(a) on Form 720
Diesel fuel, gallons delivered in a two-party exchange within a terminal
Kerosene, gallons received in a two-party exchange within a terminal, included on IRS No. 35(a),
69, 77, or 111 on Form 720
Kerosene, gallons delivered in a two-party exchange within a terminal
Gasoline, gallons received in a two-party exchange within a terminal, included on IRS No. 62(a)
on Form 720
Gasoline, gallons delivered in a two-party exchange within a terminal
Aviation gasoline, gallons received in a two-party exchange within a terminal,
included on IRS No. 14 on Form 720
Aviation gasoline, gallons delivered in a two-party exchange within a terminal
Form 720 (Rev. 4-2013)
Form 720 (Rev. 4-2013)
Page 4
Schedule C Claims
Month your income tax year ends
▶
• Complete Schedule C for claims only if you are reporting liability in Part I or II of Form 720.
• Attach a statement explaining each claim as required. Include your name and EIN on the statement (see instructions).
Caution. Claimant has the name and address of the person(s) who sold the fuel to the claimant, the dates of purchase, and if exported, the required
proof of export. For claims on lines 1a and 2b (type of use 13 and 14), 3c, 4b, and 5, claimant has not waived the right to make the claim.
For alternative fuel mixtures produced after December 31, 2011, the alternative fuel mixture credit can be taken as a credit only on Schedule C (Form
720) against your taxable fuel liability (gasoline, diesel fuel, and kerosene) reported on this form, and any excess is not allowed. The credit cannot be
claimed on any other form, including Form 4136, Credit for Federal Tax Paid on Fuels and Schedule 3 (Form 8849), Certain Fuel Mixtures and the
Alternative Fuel Credit.
1 Nontaxable Use of Gasoline
Note. CRN is credit reference number.
Period of claim
▶
Type of use Rate Gallons Amount of claim CRN
a Gasoline (see Caution above line 1)
$
362
b Exported (see Caution above line 1)
411
2 Nontaxable Use of Aviation Gasoline
Period of claim
▶
Type of use Rate Gallons Amount of claim CRN
a Used in commercial aviation (other than foreign trade)
$
354
b
Other nontaxable use (see Caution above line 1)
324
c
Exported (see Caution above line 1)
412
d LUST tax on aviation fuels used in foreign trade
433
3 Nontaxable Use of Undyed Diesel Fuel
Period of claim
▶
Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
Type of use Rate Gallons Amount of claim CRN
a Nontaxable use
$
360
b
Use in trains 353
c
Use in certain intercity and local buses (see Caution above line 1)
350
d
Use on a farm for farming purposes
360
e Exported (see Caution above line 1)
413
4
Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation) Period of claim
▶
Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
Caution. Claims cannot be made on line 4 for kerosene sales from a blocked pump.
Type of use Rate Gallons Amount of claim CRN
a Nontaxable use
$
346
b
Use in certain intercity and local buses (see Caution above line 1)
347
c
Use on a farm for farming purposes
346
d
Exported (see Caution above line 1)
414
e
Nontaxable use taxed at $.044 377
f Nontaxable use taxed at $.219 369
5 Kerosene Used in Aviation (see Caution above line 1)
Period of claim
▶
Type of use Rate Gallons Amount of claim CRN
a Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244
$
417
b
Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219
355
c
Nontaxable use (other than use by state or local
government) taxed at $.244
346
d
Nontaxable use (other than use by state or local
government) taxed at $.219
369
e
LUST tax on aviation fuels used in foreign trade
433
Form 720 (Rev. 4-2013)
$.183
.184
$.15
.193
.194
.001
$.243
.243
.17
.243
.244
$.243
.17
.243
.244
.043
.218
$.200
.175
.243
.218
.001
Form 720 (Rev. 4-2013)
Page 5
6 Nontaxable Use of Alternative Fuel
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).
Type of use Rate
Gallons or gasoline
gallon equivalents
(GGE)
Amount of claim
CRN
a
Liquefied petroleum gas (LPG)
$
419
b
“P Series” fuels 420
c
Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)
421
d
Liquefied hydrogen
422
e
Fischer-Tropsch process liquid fuel from coal (including peat)
423
f
Liquid fuel derived from biomass
424
g
Liquefied natural gas (LNG)
425
h
Liquefied gas derived from biomass
435
7
Sales by Registered Ultimate Vendors of Undyed Diesel Fuel
Period of claim
▶
Registration number
▶
Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained
written consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
Rate Gallons Amount of claim CRN
a Use by a state or local government
$
360
b Use in certain intercity and local buses
350
8
Sales by Registered Ultimate Vendors of Undyed Kerosene
(Other Than Kerosene For Use in Aviation)
Period of claim
▶
Registration number
▶
Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the
written consent of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
Rate
Gallons
Amount of claim
CRN
a Use by a state or local government
$
346
b
Sales from a blocked pump
c Use in certain intercity and local buses
347
9
Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation
Registration number
▶
Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the
buyer, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to make the claim. See the
instructions for additional information to be submitted.
Type of use Rate Gallons Amount of claim CRN
a
Use in commercial aviation (other than foreign trade) taxed at $.219
$
355
b
Use in commercial aviation (other than foreign trade) taxed at $.244
417
c
Nonexempt use in noncommercial aviation
418
d
Other nontaxable uses taxed at $.244 346
e
Other nontaxable uses taxed at $.219 369
f LUST tax on aviation fuels used in foreign trade
433
10
Sales by Registered Ultimate Vendors of Gasoline
Registration number
▶
Claimant sold the gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the
amount of tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired
certificate from the buyer and has no reason to believe any information in the certificate is false. See the instructions for
additional information to be submitted.
Rate Gallons Amount of claim CRN
a Use by a nonprofit educational organization
$
362
b Use by a state or local government
11
Sales by Registered Ultimate Vendors of Aviation Gasoline
Registration number
▶
Claimant sold the aviation gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount
of tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired certificate from the buyer
and has no reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.
Rate Gallons Amount of claim CRN
a Use by a nonprofit educational organization
$
324
b Use by a state or local government
Form 720 (Rev. 4-2013)
$.183
$.243
.17
$.243
.17
$.175
$.183
$.193
Form 720 (Rev. 4-2013)
Page 6
12 Reserved
Period of claim
▶
Registration number
▶
Reserved
Rate Gallons Amount of claim CRN
a Reserved
$
b Reserved
13
Biodiesel or Renewable Diesel Mixture Credit
Period of claim
▶
Registration number
▶
Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM
D6751 and met EPA's registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a
fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel
Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing renewable diesel with liquid fuel (other than renewable diesel).
The renewable diesel used to produce the renewable diesel mixture was derived from biomass, met EPA's registration requirements for fuels
and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. The mixture was sold by the claimant to any
person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, Statement
of Biodiesel Reseller, both of which have been edited as discussed in the instructions for line 13. See the instructions for line 13 for information
about renewable diesel used in aviation.
Rate
Gal. of biodiesel or
renewable diesel
Amount of claim
CRN
a Biodiesel (other than agri-biodiesel) mixtures
$
388
b
Agri-biodiesel mixtures 390
c Renewable diesel mixtures 307
14
Alternative Fuel Credit and Alternative Fuel Mixture Credit
Registration number
▶
For the alternative fuel mixture credit, claimant produced a mixture by mixing taxable fuel with alternative fuel. Claimant certifies that it (a)
produced the alternative fuel, or (b) has in its possession the name, address, and EIN of the person(s) that sold the alternative fuel to the
claimant; the date of purchase; and an invoice or other documentation identifying the amount of the alternative fuel. The claimant also
certifies that it made no other claim for the amount of the alternative fuel, or has repaid the amount to the government. The alternative fuel
mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant.
Rate
Gallons or
gasoline gallon
equivalents (GGE)
(see instructions)
Amount of claim
CRN
a Liquefied petroleum gas (LPG)
$
426
b
"P Series" fuels 427
c
Compressed natural gas (CNG) (GGE = 121 cu. ft.)
428
d
Liquefied hydrogen
429
e
Fischer-Tropsch process liquid fuel from coal (including peat) 430
f
Liquid fuel derived from biomass
431
g
Liquefied natural gas (LNG)
432
h
Liquefied gas derived from biomass
436
i Compressed gas derived from biomass (GGE = 121 cu. ft.)
437
15
Other claims. See the instructions. For lines 15b and 15c, see the Caution above line 1 on page 4.
Amount of claim CRN
a Section 4051(d) tire credit (tax on vehicle reported on IRS No. 33)
$
366
b
Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001
415
c
Exported dyed kerosene
416
d
Diesel-water fuel emulsion
e Registered credit card issuers
Number of tires Amount of claim CRN
f Taxable tires other than bias ply or super single tires
$
396
g
Taxable tires, bias ply or super single tires (other than super single tires designed for steering)
304
h Taxable tires, super single tires designed for steering
305
i
j
k
16
Total claims. Add amounts on lines 1 through 15. Enter the result here and on Form 720, Part III, line 4.
16
Form 720 (Rev. 4-2013)
$1.00
$.50
Form 720-V,
Payment Voucher
Purpose of Form
Complete Form 720-V if you are making a payment by
check or money order with Form 720, Quarterly
Federal Excise Tax Return. We will use the completed
voucher 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 and a
payment is required, provide this payment voucher to
the return preparer.
Do not file Form 720-V if you are paying the balance
due on line 10 of Form 720 using EFTPS.
Specific Instructions
Box 1. If you do not have an EIN, you may apply for
one online. Go to the IRS website at
www.irs.gov/businesses/small and click on the
"Employer ID Numbers (EINs)" link. You may also apply
for an EIN by calling 1-800-829-4933, or you can fax
or mail Form SS-4, Application for Employer
Identification Number, to the IRS. However, if you are
making a one-time filing, enter your social security
number.
Box 2. Enter the amount paid from line 10 of
Form 720.
Box 3. Darken the circle identifying the quarter for which
the payment is made. Darken only one circle.
Box 4. Enter your name and address as shown on
Form 720.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your
EIN, (SSN for one-time filing), “Form 720,” and the tax
period on your check or money order. Do not send cash.
Do not staple this voucher or your payment to
the return (or to each other).
• Detach the completed voucher and send it with your
payment and Form 720. See Where To File on page 1
of the Instructions for Form 720.
▼
Detach Here and Mail With Your Payment and Form 720. ▼
Form
720-V (2013)
720-V
Department of the Treasury
Internal Revenue Service
Payment Voucher
▶
Do not staple or attach this voucher to your payment.
OMB No. 1545-0023
2013
1 Enter your employer identification
number (EIN) (see instructions).
2
Enter the amount of your payment.
▶
Make your check or money order payable to “United States
Treasury.”
Dollars Cents
3 Tax Period
1st
Quarter
2nd
Quarter
3rd
Quarter
4th
Quarter
4 Enter your business name (individual name if sole proprietor).
Enter your address.
Enter your city, state, and ZIP code.
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Form 720: Quarterly Federal Excise Tax Return (IRS)

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