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

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Form 720: Quarterly Federal Excise Tax Return (MidAmerica)

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Form
720
(Rev. June 2021)
Department of the Treasury
Internal Revenue Service
Quarterly Federal Excise Tax Return
▶
See the Instructions for Form 720.
▶
Go to www.irs.gov/Form720 for instructions and the latest information.
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.)
City or town, state or province, country, and ZIP or foreign postal code
Employer identification number
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 $.244
60 (b)
Diesel, tax on taxable events other than removal at terminal rack
.244
60
(c) Diesel, tax on sale or removal of biodiesel mixture
(not at terminal rack) .244
104 Diesel-water fuel emulsion .198 104
105 Dyed diesel, LUST tax .001 105
107 Dyed kerosene, LUST tax .001 107
119 LUST tax, other exempt removals (see instructions) .001 119
35
(a) Kerosene, tax on removal at terminal rack (see instructions) .244
(b)
Kerosene, tax on taxable events other than removal at terminal rack
.244 35
69 Kerosene for use in aviation (see instructions) .219 69
77
Kerosene for use in commercial aviation (other than foreign trade)
.044 77
111 Kerosene for use in aviation, LUST tax on nontaxable uses .001 111
79 Other fuels (see instructions) 79
62
(a) Gasoline, tax on removal at terminal rack .184
(b)
Gasoline, tax on taxable events other than removal at terminal rack
.184 62
13 Any liquid fuel used in a fractional ownership program aircraft .141 13
14 Aviation gasoline .194 14
112 Liquefied petroleum gas (LPG) (see instructions) .183 112
118 “P Series” fuels .184 118
120 Compressed natural gas (CNG) (see instructions) .183 120
121 Liquefied hydrogen .184 121
122 Fischer-Tropsch process liquid fuel from coal (including peat) .244 122
123 Liquid fuel derived from biomass .244 123
124
Liquefied natural gas (LNG) (see instructions) .243 124
}
}
}
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10175Y
Form 720 (Rev. 6-2021)
Form 720 (Rev. 6-2021)
Page 2
IRS No.
Rate Tax
IRS No.
33 Retail Tax—Truck, trailer, and semitrailer chassis and bodies, and tractor
12% of sales price
33
Ship Passenger Tax
Number of persons Rate Tax
29 Transportation by water $3 per person 29
Other Excise Tax
Amount of obligations
Rate Tax
31 Obligations not in registered form $.01 31
Foreign Insurance Taxes—Policies issued by foreign insurers
Premiums paid Rate
Tax
IRS No.
Casualty insurance and indemnity bonds
$.04
30 Life insurance, sickness and accident policies, and annuity
contracts
.01 30
Reinsurance .01
}
Manufacturers Taxes
Number of tons Sales price
36
Coal—Underground mined
$1.10 per ton
36
37
4.4% of sales price
37
38
Coal—Surface mined
$.55 per ton
38
39
4.4% of sales price
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
Reserved for future use
Sales price
2.3% of sales price
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
(see inst.)
(b) Rate for
avg.
covered life
(c) Fee (see
instructions)
Tax IRS No.
Specified health insurance policies
(a) With a policy year ending before October 1, 2020 $2.54
(b) With a policy year ending on or after October 1, 2020,
and before October 1, 2021
$2.66
133 Applicable self-insured health plans
133
(c) With a plan year ending before October 1, 2020 $2.54
(d) With a plan year ending on or after October 1, 2020,
and before October 1, 2021
$2.66
Rate
Tax
41 Sport fishing equipment (other than fishing rods and fishing poles)
10% of sales price
41
110 Fishing rods and fishing poles (limits apply, see instructions)
10% of sales price
110
42 Electric outboard motors
3% of sales price
42
114 Fishing tackle boxes
3% of sales price
114
44 Bows, quivers, broadheads, and points
11% of sales price
44
106 Arrow shafts $.53 per shaft 106
140 Indoor tanning services
10% of amount paid
140
Number of gallons Rate Tax
64 Inland waterways fuel use tax $.29 64
125 LUST tax on inland waterways fuel use (see instructions) .001 125
51
Section 40 fuels (see instructions)
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
▶
$
Form 720 (Rev. 6-2021)
Form 720 (Rev. 6-2021)
Page 3
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 720-X 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
Type or print name below signature.
▶
Date
▲
Title
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. 6-2021)
Form 720 (Rev. 6-2021)
Page
4
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. Don’t 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 Form 720, IRS No. 60(a)
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 Form 720, IRS No. 35(a), 69, 77, or 111
Kerosene, gallons delivered in a two-party exchange within a terminal
Gasoline, gallons received in a two-party exchange within a terminal, included
on Form 720, IRS No. 62(a)
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 Form 720, IRS No. 14
Aviation gasoline, gallons delivered in a two-party exchange within a terminal
Form 720 (Rev. 6-2021)
Form 720 (Rev. 6-2021)
Page 5
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 hasn’t waived
the right to make the claim.
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) $.183
$
362
b Exported (see Caution above line 1) .184 411
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) $.15
$
354
b
Other nontaxable use (see Caution above line 1) .193 324
c
Exported (see Caution above line 1) .194 412
d LUST tax on aviation fuels used in foreign trade .001 433
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 $.243
$
360
b
Use in trains .243 353
c
Use in certain intercity and local buses (see Caution above line 1)
.17 350
d
Use on a farm for farming purposes .243 360
e Exported (see Caution above line 1) .244 413
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 $.243
$
346
b
Use in certain intercity and local buses (see Caution above line 1)
.17 347
c
Use on a farm for farming purposes .243 346
d
Exported (see Caution above line 1) .244 414
e
Nontaxable use taxed at $.044 .043 377
f Nontaxable use taxed at $.219 .218 369
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
$.200
$
417
b
Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219
.175 355
c
Nontaxable use (other than use by state or local
government) taxed at $.244
.243 346
d
Nontaxable use (other than use by state or local
government) taxed at $.219
.218 369
e LUST tax on aviation fuels used in foreign trade
.001 433
Form 720 (Rev. 6-2021)
Form 720 (Rev. 6-2021)
Page 6
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
or diesel gallon
equivalents
Amount of claim
CRN
a Liquefied petroleum gas (LPG) (see instructions) $.183
$
419
b
“P Series” fuels .183 420
c
Compressed natural gas (CNG) (see instructions) .183 421
d
Liquefied hydrogen .183 422
e
Fischer-Tropsch process liquid fuel from coal (including peat)
.243 423
f
Liquid fuel derived from biomass .243 424
g
Liquefied natural gas (LNG) (see instructions) .243 425
h Liquefied gas derived from biomass .183 435
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 didn’t 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 $.243
$
360
b Use in certain intercity and local buses .17 350
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 didn’t 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
346
Rate
Gallons
Amount of claim
CRN
a Use by a state or local government $.243
$
b Sales from a blocked pump .243
c Use in certain intercity and local buses .17 347
9
Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation
Registration number
▶
• See Caution above line 1.
• Claimant sold the kerosene for use in aviation at a tax-excluded price and hasn’t 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
$.175
$
355
b
Use in commercial aviation (other than foreign trade) taxed at $.244
.200 417
c
Nonexempt use in noncommercial aviation .025 418
d
Other nontaxable uses taxed at $.244 .243 346
e
Other nontaxable uses taxed at $.219 .218 369
f LUST tax on aviation fuels used in foreign trade .001 433
10 Sales by Registered Ultimate Vendors of Gasoline
Registration number
▶
Claimant sold the gasoline at a tax-excluded price and hasn’t 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 $.183
$
b Use by a state or local government
.183
362
Form 720 (Rev. 6-2021)
Form 720 (Rev. 6-2021)
Page 7
11 Sales by Registered Ultimate Vendors of Aviation Gasoline Registration number
▶
Claimant sold the aviation gasoline at a tax-excluded price and hasn’t 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 $.193
$
b Use by a state or local government .193
324
12
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 12. See the instructions for line 12
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 $1.00
$
388
b
Agri-biodiesel mixtures 1.00 390
c Renewable diesel mixtures 1.00 307
13 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 or diesel
gallon equivalents
(see instructions)
Amount of claim
CRN
a Liquefied petroleum gas (LPG)* $.50
$
426
b
“P Series” fuels .50 427
c
Compressed natural gas (CNG)* .50 428
d
Liquefied hydrogen .50 429
e
Fischer-Tropsch process liquid fuel from coal (including peat) .50 430
f
Liquid fuel derived from biomass .50 431
g
Liquefied natural gas (LNG)* .50 432
h
Liquefied gas derived from biomass* .50 436
i
Compressed gas derived from biomass* .50 437
* You can’t claim the alternative fuel mixture credit for this fuel.
14
Other claims. See the instructions. For lines 14b and 14c, see the Caution above line 1 on page 5.
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
15
Total claims. Add amounts on lines 1 through 14. Enter the result here and on Form 720, Part III, line 4.
15
Form 720 (Rev. 6-2021)
Form 720-V,
Payment Voucher
Purpose of Form
Complete Form 720-V if you’re 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.
Don’t file Form 720-V if you’re paying the balance
due on line 10 of Form 720 using EFTPS.
Specific Instructions
Box 1. If you don’t have an EIN, you may apply for
one online by visiting www.irs.gov/EIN. You may also
apply for an EIN by faxing or mailing Form SS-4,
Application for Employer Identification Number, to the
IRS. However, if you’re 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. Don’t send cash.
Don’t 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 in the
Instructions for Form 720.
▼
Detach here and mail with your payment and Form 720. ▼
Form
720-V (2021)
Form
720-V
Department of the Treasury
Internal Revenue Service
Payment Voucher
OMB No. 1545-0023
2021
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.
City or town, state or province, country, and ZIP or foreign postal code
▶
Don’t staple or attach this voucher to your payment.
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Form 720: Quarterly Federal Excise Tax Return (MidAmerica)

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