Form 2290
(Rev. July 2017)
Department of the Treasury
Internal Revenue Service (99)
Heavy Highway Vehicle Use Tax Return
For the period July 1, 2017, through June 30, 2018
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Attach both copies of Schedule 1 to this return.
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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). Attach an explanation to the
return. Don’t 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. Don’t 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 2017? If “YES,”
enter 201707 in the boxes to the right. If
“NO,” see the table on page 3 of the instructions .
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1
Y Y Y Y M M
2 Tax. Enter the Total from Form 2290, page 2, column (4) . . . . . . . . . . .
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2 .
3 Additional tax from increase in taxable gross weight (see instructions) . . . . . . .
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3 .
4 Total tax. Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . .
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4 .
5 Credits (Attach supporting documentation. See instructions.) . . . . . . . . .
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5 .
6
Balance due. Subtract line 5 from line 4. This is the amount you owe. If payment through
EFTPS, check here . . . . . . . . . . . . . . . . . . . . . .
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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, 2017, through June 30, 2018, 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, 2016, through June 30, 2017, were
not subject to the tax for that period except for any vehicles listed on line 8b. Check this box if applicable.
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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, 2016, through June 30, 2017. 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
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Phone
no.
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Personal identification
number (PIN)
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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.
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Signature
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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
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Firm’s EIN
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Firm’s address
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Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11250O
Form 2290 (Rev. 7-2017)
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