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You must file this Form 2290 (Rev. July (IRS)

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Attention:
You must file this Form 2290 (Rev. July 2016) for the tax period beginning
on July 1, 2016, and ending on June 30, 2017. Do not use this revision if
you need to file a return for a tax period that began on or before June 30,
2016. To obtain a prior revision of Form 2290 and its separate instructions,
visit
www.irs.gov/form2290
.
THIS PAGE INTENTIONALLY LEFT BLANK.
Form 2290
(Rev. July 2016)
Department of the Treasury
Internal Revenue Service (99)
Heavy Highway Vehicle Use Tax Return
For the period July 1, 2016, through June 30, 2017
▶
Attach both copies of Schedule 1 to this return.
▶
Information about Form 2290 and its separate instructions is at www.irs.gov/form2290.
Keep a copy of this
return for your records.
OMB No. 1545-0143
Type
or Print
Name
Employer identification number
–
Address (number, street, and room or suite no.)
City or town, state or province, country, and ZIP or foreign postal code
Check if applicable:
Address change
VIN Correction
Check this box if you are correcting a vehicle
identification number (VIN) listed on a previously filed
Schedule 1 (Form 2290). Do not check this box for any
other reason.
Amended Return
Check this box if reporting (a) additional tax from an
increase in taxable gross vehicle weight or (b) suspended
vehicles exceeding the mileage use limit. Do not check
this box for any other reason.
Final Return
Check this box if you no longer have taxable vehicles to
report.
Part I
Figuring the Tax
Caution: If you purchased a used vehicle from a private seller, see instructions.
1
Was the vehicle(s) reported on this return used on public highways during July 2016? If YES,
enter 201607 in the boxes to the right. If NO, see the table on page 3 of the instructions .
▶
1
Y Y Y Y M M
2 Tax. Enter the Total from Form 2290, page 2, column (4) . . . . . . . . . . .
▶
2 .
3 Additional tax from increase in taxable gross weight (see instructions) . . . . . . .
▶
3 .
4 Total tax. Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . .
▶
4 .
5 Credits (see instructions) . . . . . . . . . . . . . . . . . . . . . .
▶
5 .
6
Balance due. Subtract line 5 from line 4. This is the amount you owe. If payment through
EFTPS, check here . . . . . . . . . . . . . . . . . . . . . .
▶
6 .
Part II
Statement in Support of Suspension (Complete the statements that apply. Attach additional sheets if needed.)
7
I declare that the vehicles reported on Schedule 1 as suspended (category W) are expected to be used on public highways
(check the boxes that apply):
5,000 miles or less 7,500 miles or less for agricultural vehicles
during the period July 1, 2016, through June 30, 2017, and are suspended from the tax. Complete and attach Schedule 1.
8
a
I declare that the vehicles listed as suspended on the Form 2290 filed for the period July 1, 2015, through June 30, 2016, were
not subject to the tax for that period except for any vehicles listed on line 8b. Check this box if applicable.
▶
b
Vehicle identification numbers
9
I declare that vehicle identification numbers
were listed as suspended on the Form 2290 filed for the period July 1, 2015, through June 30, 2016. These vehicles were sold or
transferred to
on
,
.
At the time of the transfer, the vehicles were still eligible for the suspension of the tax. Attach a separate list if needed.
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’s
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
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 EIN
▶
Firm’s address
▶
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11250O
Form 2290 (Rev. 7-2016)
Form 2290 (Rev. 7-2016)
Page 2
Tax Computation
Category
Taxable gross weight
(in pounds)
(1)
Annual tax
(vehicles used
during July)
(a)
Vehicles
except
logging*
(b)
Logging
vehicles*
(2)
Partial-period tax
(vehicles first used after July)
See the tables at the end of
the separate instructions.
(a)
Vehicles
except logging*
(b)
Logging
vehicles*
(3)
Number of
vehicles
(a)
Vehicles
except logging*
(b)
Logging
vehicles*
(4)
Amount of tax
(col. (1) or (2)
multiplied by
col. (3))
Category
$ $ $
Totals. Add the number of vehicles in columns (3a) and (3b). Enter the total here
(this should be the same total of taxable vehicles shown on Schedule 1, Part II, line c).
Add the amounts in column (4). Enter the total here and on Form 2290, line 2 . .
▶
$
W
Tax-Suspended Vehicles
(See Part II on page 7 of
the instructions.)
Complete both copies of Schedule 1 (Form 2290) and attach them to Form 2290.
* See page 2 of the instructions for information on logging vehicles.
Form 2290 (Rev. 7-2016)
A
55,000
$100.00
$75.00
A
B
55,001 – 56,000
122.00
91.50
B
C
56,001 – 57,000
144.00
108.00
C
D
57,001 – 58,000
166.00
124.50
D
E
58,001 – 59,000
188.00
141.00
E
F
59,001 – 60,000
210.00
157.50
F
G
60,001 – 61,000
232.00
174.00
G
H
61,001 – 62,000
254.00
190.50
H
I
62,001 – 63,000
276.00
207.00
I
J
63,001 – 64,000
298.00
223.50
J
K
64,001 – 65,000
320.00
240.00
K
L
65,001 – 66,000
342.00
256.50
L
M
66,001 – 67,000
364.00
273.00
M
N
67,001 – 68,000
386.00
289.50
N
O
68,001 – 69,000
408.00
306.00
O
P
69,001 – 70,000
430.00
322.50
P
Q
70,001 – 71,000
452.00
339.00
Q
R
71,001 – 72,000
474.00
355.50
R
S
72,001 – 73,000
496.00
372.00
S
T
73,001 – 74,000
518.00
388.50
T
U
74,001 – 75,000
540.00
405.00
U
V
over 75,000
550.00
412.50
V
SCHEDULE 1
(Form 2290)
(Rev. July 2016)
Department of the Treasury
Internal Revenue Service
Schedule of Heavy Highway Vehicles
For the period July 1, 2016, through June 30, 2017
▶
Complete and file both copies of Schedule 1. One copy will be stamped and returned to
you for use as proof of payment when registering vehicle(s) with a state.
OMB No. 1545-0143
Type
or Print
Name
Employer identification number
–
Address (number, street, and room or suite no.)
City or town, state or province, country, and ZIP or foreign postal code
Part I
Vehicles You Are Reporting (enter VIN and category)
Category A through W
(category W for
suspended vehicles)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Part II
Summary of Reported Vehicles
a Total number of reported vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . a
b Enter the total number of taxable vehicles on which the tax is suspended (category W) . . . . . . . . b
c
Total number of taxable vehicles. Subtract line b from line a . . . . . . . . . . . . . . . . .
c
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11250O Schedule 1 (Form 2290) (Rev. 7-2016)
THIS PAGE INTENTIONALLY LEFT BLANK
SCHEDULE 1
(Form 2290)
(Rev. July 2016)
Department of the Treasury
Internal Revenue Service
Schedule of Heavy Highway Vehicles
For the period July 1, 2016, through June 30, 2017
▶
Complete and file both copies of Schedule 1. One copy will be stamped and returned to
you for use as proof of payment when registering vehicle(s) with a state.
OMB No. 1545-0143
Type
or Print
Name
Employer identification number
–
Address (number, street, and room or suite no.)
City or town, state or province, country, and ZIP or foreign postal code
Part I
Vehicles You Are Reporting (enter VIN and category)
Category A through W
(category W for
suspended vehicles)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Part II
Summary of Reported Vehicles
a Total number of reported vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . a
b Enter the total number of taxable vehicles on which the tax is suspended (category W) . . . . . . . . b
c
Total number of taxable vehicles. Subtract line b from line a . . . . . . . . . . . . . . . . .
c
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11250O Schedule 1 (Form 2290) (Rev. 7-2016)
THIS PAGE INTENTIONALLY LEFT BLANK
Schedule 1 (Form 2290) (Rev. 7-2016)
Consent to Disclosure of Tax Information
For the period July 1, 2016, through June 30, 2017
By signing, dating, and entering my employer identification number below, I hereby consent to the
Internal Revenue Service (IRS) disclosing information about my payment of the heavy highway
vehicle use tax (HVUT) for the tax period listed above to the federal Department of Transportation
(DOT), U.S. Customs and Border Protection (CBP), and to state Departments of Motor Vehicles
(DMV). The information disclosed to the DOT, CBP, and state DMVs will be my vehicle identification
number (VIN) and verification that I have paid the HVUT. The IRS may disclose the information to the
DOT, CBP, and to the DMVs of the 50 states and the District of Columbia who have other taxing,
registration, or information collecting authority. I agree that the American Association of Motor
Vehicle Administrators (AAMVA), a third-party nonprofit organization, may be used as an
intermediary to transmit my VIN and payment information from the IRS to the state DMVs.
I understand that the information to be disclosed is generally confidential under the laws
applicable to the IRS and that the agency receiving the HVUT information is not bound by these laws
and may use the information for any purpose as permitted by other federal laws and/or state law. To
be effective, this consent must be received by the IRS within 120 days of the date below.
If signed by a corporate officer or party other than the taxpayer, I certify that I have the authority to
execute this consent to disclosure of tax information.
Sign
Here
▶
Signature
▶
Date
Type or print name below signature.
▶
Employer identification number
–
Schedule 1 (Form 2290) (Rev. 7-2016)
Form 2290-V, Payment Voucher
Purpose of Form
Complete Form 2290-V if you are making a payment by
check or money order with Form 2290, Heavy Highway
Vehicle Use Tax Return. We will use Form 2290-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 and a
payment is required, provide Form 2290-V to the return
preparer.
Do not file Form 2290-V if you are paying the balance
due on Form 2290, line 6, using the Electronic Federal
Tax Payment System (EFTPS) or electronic funds
withdrawal (direct debit). See How To Pay the Tax in the
Instructions for Form 2290.
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
faxing or mailing Form SS-4, Application for Employer
Identification Number, to the IRS.
Box 2. Enter the amount paid from Form 2290, line 6.
Box 3. Enter the date as shown on Form 2290, line 1.
Box 4. Enter your name and address as shown on Form
2290.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 2290,” and the tax period on your check or money
order. Do not send cash. Do not staple Form 2290-V or
your payment to Form 2290 (or to each other).
• Detach Form 2290-V and send it with your payment and
Form 2290 to the address shown in the bottom left corner
of Form 2290-V.
▲
Detach here
▲
Form
2290-V
(Rev. July 2016)
Department of the Treasury
Internal Revenue Service
Payment Voucher
For the period July 1, 2016, through June 30, 2017
▶
See How To Pay the Tax in the Instructions for Form 2290.
▶
Do not staple or attach this voucher or your payment to your return.
OMB No. 1545-0143
1
Employer identification number
–
2
Enter the amount of your payment. Make
your check or money order payable to
“United States Treasury”
Dollars Cents
3
Enter date as shown on line 1 of Form 2290.
Y Y Y Y M M
Send Form 2290, this voucher, and payment to:
Internal Revenue Service
P.O. Box 804525
Cincinnati, OH 45280-4525
4
Name
Address (number, street, and room or suite no.)
City or town, state or province, country, and ZIP or foreign postal code
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Completed 22 March 2022

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