Form 2290 Heavy Highway Vehicle Use Tax Return

(Rev. July 2001) For the period July 1, 2001, through June 30, 2002

Department of the Treasury

Internal Revenue Service

 Attach both copies of Schedule 1 to this return.

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and, to the best of my knowledge

and belief, they are true, correct, and complete.

Signature

(Please type or print name below signature.)

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11250O Form 2290 (Rev. 7-2001)

OMB No. 1545-0143

FOR IRS

USE ONLY

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Name

Check here if:

City, state, and ZIP code (For Canadian or Mexican address, see instructions.)

Address (number, street, and room or suite no.)

Employer identification number

Detach here

OMB No. 1545-0143

Form 2290-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

The first four letters of your last name or

your business name

1

5 Name

 Do not staple or attach this voucher or your payment to your return.

Address

(99)

See the Voucher Instructions on page 6.

2 Employer identification number 3 Amount of the payment you are making

$ .

Send Form 2290, this voucher, and payment to:

Internal Revenue Service

P.O. Box 6229

Chicago, IL 60680-6229

Telephone number ( )

4 Enter date as shown on line 1 of Form 2290.

(Rev. July 2001)

Type

or Print

Address

change

Final return

YYYM

For the period July 1, 2001, through June 30, 2002

Keep a copy of this

return for your records.

T

Was the vehicle(s) reported on this return used on public highways during July 2001?

If YES, enter 200107 in the boxes to the right. If NO, see the instructions on page 3 

Total tax. Enter the Totals from Form 2290, page 2, column (4)

1

Additional tax from increase in taxable gross weight. See the instructions on page 3 

2

Credits. See the instructions on page 3 

3

Tax as adjusted. Add lines 2 and 3, then subtract line 4 from the total. This is the amount

you owe. If paying in installments, go to line 6 

4

Installment payment. See the instructions on page 6

5

I declare that the vehicles listed in Part II of Schedule 1 are expected to be used on public highways (check the boxes that

apply):

6

8a I declare that the vehicles listed as suspended on the Form 2290 filed for July 1, 2000, through June 30, 2001, were not subject

to the tax for that period except for any vehicles listed on line 8b. Check this box if applicable. 

9 I declare that vehicle identification numbers

were listed as suspended on the Form 2290 filed for July 1, 2000, through June 30, 2001. 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.)

5,000 miles or less 7,500 miles or less for agricultural vehicles

during the period July 1, 2001, through June 30, 2002 and are suspended from the tax. Complete and attach Schedule 1.

Part I

Part II

Figuring the Tax

Y YMM

Statement in Support of Suspension (Complete the statements that apply. Attach additional sheets if needed.)

7

1

2

3

4

5

6

Y Y

 See the separate instructions.

City, state, and ZIP code (For Canadian or Mexican addresses, see instructions.)

Y M

b Vehicle identification numbers

Sign

Here   Date
Tax Computation

(2)

Partial-period tax rate

(vehicles first used after July)

(See the tables on page 5 of

the separate instructions.)

(4)

Amount of tax

(col. (1) or (2)

times col. (3))

(1)

Annual tax rate

(vehicles used

during July)

(3)

Number of

vehicles

Category

(b)

Logging or

Canadian/

Mexican*

Vehicles

(a)

Vehicles Except

Logging or

Canadian/

Mexican*

(b)

Logging or

Canadian/

Mexican*

Vehicles

(a)

Vehicles Except

Logging or

Canadian/

Mexican*

(b)

Logging or

Canadian/

Mexican*

Vehicles

(a)

Vehicles Except

Logging or

Canadian/

Mexican*

Taxable Gross Weight

(in pounds)

55,000 $100.00 $75.00 A

55,001 – 56,000 122.00 91.50 B

56,001 – 57,000 144.00 108.00 C

57,001 – 58,000 166.00 124.50 D

58,001 – 59,000 188.00 141.00 E

59,001 – 60,000 210.00 157.50 F

60,001 – 61,000 232.00 174.00 G

61,001 – 62,000 254.00 190.50 H

62,001 – 63,000 276.00 207.00 I

63,001 – 64,000 298.00 223.50 J

64,001 – 65,000 320.00 240.00 K

65,001 – 66,000 342.00 256.50 L

66,001 – 67,000 364.00 273.00 M

67,001 – 68,000 386.00 289.50 N

68,001 – 69,000 408.00 306.00 O

69,001 – 70,000 430.00 322.50 P

70,001 – 71,000 452.00 339.00 Q

71,001 – 72,000 474.00 355.50 R

72,001 – 73,000 496.00 372.00 S

73,001 – 74,000 518.00 388.50 T

74,001 – 75,000 540.00 405.00 U

Over 75,000 550.00 412.50 V

Tax-Suspended Vehicles

(See Part II on page 4 of

the separate instructions.)

W

* See the separate instructions on page 8 for information on logging and Canadian/Mexican vehicles.

Totals. Add the number of vehicles in columns (3a) and (3b). Enter the total

here and on Schedule 1, Part III, line a. Add the amounts in column (4). Enter

the total here and on Form 2290, line 2

Form 2290 (Rev. 7-2001) Page 2

Complete both copies of Schedule 1 (Form 2290) on page 4 and attach them to Form 2290.

$$ $

$

Form 2290 (Rev. 7-2001)

Category

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C

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SCHEDULE 1

(Form 2290)

OMB No. 1545-0143 (Rev. July 2001)

Department of the Treasury

Internal Revenue Service

FOR IRS

USE ONLY

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Vehicles on Which You Are Reporting Tax. See the instructions.

Vehicle Identification Number Category Vehicle Identification Number Category

1 7

2 8

3 9

Vehicles for Which Tax Is Suspended—5,000 Miles or Less (7,500 Miles or Less for Agricultural

Vehicles). See the instructions.

Vehicle Identification Number Category Vehicle Identification Number Category

1 W 2 W

4 10

Summary of Reported Vehicles

Enter the number of taxable vehicles from Form 2290, page 2, column 3, Totals a

Enter the total number of taxable vehicles on which the tax is suspended from Form 2290, page 2, column 3 (category W) b

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

SCHEDULE 1 Schedule of Heavy Highway Vehicles (Form 2290) For the period July 1, 2001, through June 30, 2002 OMB No. 1545-0143 (Rev. July 2001)

Vehicles on Which You Are Reporting Tax. See the instructions.

Vehicle Identification Number Category Vehicle Identification Number Category

1 7

2 8

3 9

Vehicles for Which Tax Is Suspended—5,000 Miles or Less (7,500 Miles or Less for Agricultural

Vehicles). See the instructions.

Vehicle Identification Number Category Vehicle Identification Number Category

1 W 2 W

4 10

Summary of Reported Vehicles

a Enter the number of taxable vehicles from Form 2290, page 2, column 3, Totals

b Enter the total number of taxable vehicles on which the tax is suspended from Form 2290, page 2, column 3 (category W)

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

This copy will be stamped and returned to you for use as proof of payment when registering

vehicle(s) with a state.

Part III

Part I

Part II

Part III

Part I

Part II

Department of the Treasury

Internal Revenue Service

Name as shown on Form 2290 Employer identification number

Type

or

Print

Address (number, street, and room or suite no.)

City, state, and ZIP code (For Canadian or Mexican address, see instructions.)

Name as shown on Form 2290 Employer identification number

Type

or

Print

Address (number, street, and room or suite no.)

Do not cut or separate the forms on this page.

a

b

a

b

Schedule of Heavy Highway Vehicles

For the period July 1, 2001, through June 30, 2002

Complete both copies of Schedule 1 and attach them to Form 2290.

City, state, and ZIP code (For Canadian or Mexican address, see instructions.)

Caution: You must list all vehicles. Attach a separate list if needed.

Caution: You must list all vehicles. Attach a separate list if needed.

5 11

6 12

5 11

6 12

Schedule 1 (Form 2290) (Rev. 7-2001)

Schedule 1 (Form 2290) (Rev. 7-2001)