Form 11-C

(Rev. December 2012) 

Department of the Treasury 

Internal Revenue Service 

Occupational Tax and Registration Return for Wagering 

▶ Information about Form 11-C and its instructions is available at www.irs.gov/form11c.

Return for period from 

(Month and day) , (Year) 

to June 30, 

(Year) 

OMB No. 1545-0236 

Type 

or 

Print

Name Employer identification number 

Number, street, and room or suite no. 

City, state, and ZIP code 

Check one: First return Renewal return 

Supplemental registration (Do not complete lines 1, 2, 4, 5, and 6.) 

Daytime telephone number

Business address (if different from your home address or address entered above) 

Alias, style, or trade name, if any 

For IRS Use Only 

T $ 1 

FF 2 

FP 3 

I 4 

Part I Occupational Tax T $ 5 

1 Enter the date (month and day) you will start accepting wagers during the tax period . . .

2 Tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . $ 

See Form 11-C(V), Payment Voucher, for how to make your payments. 

3 Check one: Principal Agent accepting wagers for another (see instructions) 

Part II Additional Information (for principal only) 

4 If the taxpayer is a firm, partnership, or corporation, give the true name of each member or officer. 

True name Title Home address Social security number

5 Are you or will you be engaged in the business of accepting wagers on your own account? . . . . . Yes No

If “Yes,” complete a, b, and c. 

a Name and address where each business is or will be conducted: 

Name of location Address (number and street) City, state, and ZIP code

b Number of agents engaged in receiving wagers on your behalf ▶

c True name, address, and employer identification number of each agent: 

True name Address Employer identification number

For Privacy Act and Paperwork Reduction Act Notice, see page 6. Cat. No. 16166V Form 11-C (Rev. 12-2012) 
Form 11-C (Rev. 12-2012) Page 2 

Part III Additional Information (for agents accepting wagers on behalf of others) 

6 If you receive or will be receiving wagers on behalf of or as an agent for some other person or persons, give the true name, 

address, and employer identification number of each person. 

True name Address Employer identification number

Part IV Supplemental Registration (see instructions) 

7 Explain why you are filing a supplemental registration. Include the date of the event. 

Sign 

Here

Under penalties of perjury, I declare that I have examined this return and/or registration (including any accompanying statements or lists), 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 of officer Date ▲

Title

Form 11-C (Rev. 12-2012) 

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.
Form 11-C (Rev. 12-2012) Page 3 

Section references are to the Internal Revenue Code 

unless otherwise noted.

Future developments. The IRS has created a page on 

IRS.gov for information about Form 11-C and its 

instructions at www.irs.gov/form11c. Information about 

any future developments affecting Form 11-C (such as 

legislation enacted after we release it) will be posted on 

that page.

General Instructions 

Purpose of form. Form 11-C is used to register certain 

information with the IRS and to pay the occupational tax 

on wagering. You must pay the occupational tax if you 

accept taxable wagers for yourself or another person. 

There are two amounts of occupational tax ($50 or $500). 

One or the other applies depending on whether the 

wagers you accept are authorized by the laws of the state 

in which you accept the wager. See Line 2 on page 4 to 

determine your occupational tax. Your cancelled check is 

proof of registration and payment. 

Who must file. File Form 11-C if you are a principal or an 

agent. 

1. A principal is a person who is in the business of 

accepting taxable wagers for his or her own account. 

This is the person who makes a profit or risks loss 

depending on the outcome of the event or contest for 

which the wager is accepted. 

2. An agent is a person who accepts taxable wagers 

on the principal’s behalf. 

Taxable wagers include those placed: 

• On a sports event or contest with a person engaged in 

the business of accepting wagers on a sports event or 

contest. 

• In a wagering pool on a sports event or contest if the 

pool is conducted for profit. 

• In a lottery conducted for profit (other than a stateconducted lottery). The term lottery includes the numbers 

game, policy, punch boards, and similar types of 

wagering. 

What is not taxed. The tax is not imposed on the 

following five items. 

• A parimutuel wagering enterprise, including horse 

racing, dog racing, and jai alai, when licensed under the 

laws of the state in which accepted; 

• Coin-operated devices, such as pinball machines; 

• Sweepstakes, wagering pools, or lotteries that are 

conducted by an agency of a state, if the wager is placed 

with the state agency or its authorized agents or 

employees; 

• Games of the type in which usually all persons placing 

wagers in the game are present when wagers are placed, 

winners are determined, and prizes or other property are 

distributed; and

• Drawings conducted by an organization exempt from 

tax under sections 501 or 521, as long as the net 

proceeds of the drawing do not inure to the benefit of a 

private shareholder or individual.

Definitions. See the Instructions for Form 730, Monthly 

Tax Return for Wagers, for the definition of sports event, 

contest, wagering pool, and lottery. 

When to file. File the first return before wagers are 

accepted. After that, file a renewal return by July 1 for 

each year wagers are accepted. A first return is also due 

in certain situations in which there has been a change in 

ownership or control. The return must be filed within 30 

days after new members are admitted to a firm or 

partnership, a corporation is formed to continue the 

business of a partnership, or a stockholder continues the 

business of a dissolved corporation. 

Employer Identification Number (EIN). Enter your EIN. If 

you do not have an EIN, apply for one online. Go to the 

IRS website at www.irs.gov/businesses/small and click on 

the “Employer ID Numbers” 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. 

Address. If you are an individual, enter your home 

address. 

Signature. Form 11-C must be signed by a person who 

has authority to sign for the taxpayer. 

Where to file. Mail Form 11-C, your check or money 

order, and Form 11-C(V) to: 

Department of the Treasury 

Internal Revenue Service 

Cincinnati, OH 45999-0101 

Mail the return using the U.S. Postal Service or other 

designated private delivery service. See the instructions 

for your income tax return for more information about 

private delivery services. 

Penalties. There are penalties for not filing on time, for 

accepting wagers before paying the tax, and for willfully 

failing to file the return. There are also penalties for 

making or helping to make false returns, documents, or 

statements. 

If you receive a notice about penalty after you file this 

return, reply to the notice with an explanation and we will 

determine if you meet reasonable-cause criteria. Do not 

attach an explanation when you file your return.

Disclosure of information on wagering taxes. Except 

for administering or enforcing Internal Revenue taxes, 

neither the Treasury Department nor any of its 

employees may disclose documents, records, or 

information obtained through them that a taxpayer 

supplies in connection with wagering taxes. Also, certain 

documents related to wagering taxes and information 

obtained through them that relates to wagering taxes may 

not be used against the taxpayer in any nontax criminal 

proceeding. See section 4424 for more details. 

Refund. A refund for an overpayment of the occupational 

tax may be claimed on Form 8849, Claim for Refund of 

Excise Taxes, using Schedule 6. See the Instructions for 

Form 8849 for details. 

Specific Instructions 

Return period. Enter the month, day, and year the return 

period begins. Also, enter the ending year. Write the year 

as a four-digit number (for example, 2012 or 2013). 
Form 11-C (Rev. 12-2012) Page 4 

Line 1. Enter the day and month that you will start 

accepting wagers. A full month’s tax is due regardless of 

which day you start accepting wagers during a month. 

Line 2. Use the table below to determine the tax. The 

$50 tax applies if all wagers (including those accepted by 

an agent for another) are authorized under the laws of the 

state in which accepted. If you intend to accept wagers 

that are not authorized by the state, the $500 tax applies. 

The tax is payable for the period that begins July 1 of 

each year. If you start accepting wagers after July 31, the 

tax is prorated for the first year. 

Note. This tax is paid once for each period that begins 

July 1. If you are required to file a supplemental 

registration, do not pay the tax a second time. 

If you start 

accepting 

wagers in 

$500 

tax 

$50 

tax 

July . . . . . . . $500.00 . . . . $50.00 

August . . . . . . 458.33 . . . . 45.83

September . . . . 416.66 . . . . 41.66

October . . . . . 375.00 . . . . 37.50

November . . . . 333.33 . . . . 33.33

December . . . . 291.66 . . . . 29.16

January . . . . . 250.00 . . . . 25.00

February . . . . . 208.33 . . . . 20.83

March . . . . . . 166.66 . . . . 16.66

April . . . . . . . 125.00 . . . . 12.50

May . . . . . . . 83.33 . . . . 8.33

June . . . . . . 41.66 . . . . 4.16

Payment voucher. Complete Form 11-C(V), Payment 

Voucher, and file it with Form 11-C and your payment. 

Line 3. You must check one of the boxes. See Who must 

file for the definition of principal and agent. Principals are 

liable for the excise tax on wagers, which is reported and 

filed monthly on Form 730. 

Lines 4 and 5. These lines are to be completed by 

principals only. Enter applicable information for officers 

and/or partners of the company on line 4. Enter on line 

5a the name and address of each location where 

business will be conducted. Enter the number of agents 

who accept wagers for you on line 5b and their names, 

addresses, and EINs on line 5c. 

Line 6. This line is to be completed by agents accepting 

wagers on behalf of another. Enter the name, address, 

and EIN of each person or company on whose behalf you 

accept wagers. 

Supplemental Registration 

Line 7. A supplemental registration must be filed by 

principals within 30 days (except for items 1 and 7 below) 

when any of the following events occur. 

1. You change your business or home address. You 

must register the change before accepting wagers at the 

new address or by the end of the 30-day period after the 

change of address, whichever occurs first. 

2. You continue for the remainder of the period, as the 

surviving spouse or child, executor, administrator, or 

other legal representative, the business of a deceased 

person who paid the occupational tax. 

3. You continue for the remainder of the period the 

business as a receiver or trustee in bankruptcy. 

4. You continue for the remainder of the period the 

business as an assignee for creditors. 

5. One or more members withdraws from a firm or 

partnership. 

6. The corporate name is changed. 

7. You engage a new agent to receive wagers. You 

must file a supplemental registration to report the name, 

address, and EIN of each new agent within 10 days after 

you engage the agent. 

Agents. You must complete line 7 if you have 

previously filed Form 11-C and are engaged to receive 

wagers for another. You must register the name, 

address, and EIN of each new person who engaged you 

within 10 days after being engaged. 

How to file a supplemental registration. Complete the 

name, address, EIN, business address, and alias lines. 

Also, be sure to check the “supplemental registration” 

box. Then check the applicable box on line 3 and enter 

the information that has changed on line 7, including the 

date of the event of change. Do not complete lines 1, 2, 4, 

5, or 6 for a supplemental registration. 
Form 11-C(V), 

Payment Voucher 

Purpose of Form 

Complete Form 11-C(V), Payment Voucher, and file it 

with Form 11-C, Occupational Tax and Registration 

Return for Wagering. We will use Form 11-C(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, 

provide Form 11-C(V) to the return preparer. 

Specific Instructions 

Box 1. If you do not have an EIN, apply for one online. 

Go to the IRS website at www.irs.gov/businesses/small 

and click on the “Employer ID Numbers” 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. 

Box 2. Enter the amount paid with Form 11-C. 

Box 3. Enter the same year and month you entered on 

the “Return for period from” line at the top of Form 11-C. 

For example, if your return is for the full period that begins 

July 1, 2012, enter 201207. 

Box 4. Enter your name and address as shown on Form 

11-C. 

• Enclose your check or money order made payable to 

the “United States Treasury.” Be sure to enter your EIN, 

“Form 11-C,” and the tax period on your check or money 

order. Do not send cash. Do not staple Form 11-C(V) or 

your payment to Form 11-C (or to each other). 

• Detach Form 11-C(V) and send it with your payment 

and Form 11-C. See Where to file on page 3. 

▼ Detach Here and Mail With Your Payment and Form 11-C. ▼

Form 

11-C(V) 

(Rev. December 2012) 

Department of the Treasury 

Internal Revenue Service 

Payment Voucher 

▶ Do not staple or attach this voucher to your payment or Form 11-C. 

OMB No. 1545-0235 

1 Enter your 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 year and month as shown on Form 11-C. 

Y Y Y Y M M

Send Form 11-C, this voucher, and payment to: 

Department of the Treasury

Internal Revenue Service 

Cincinnati, OH 45999-0101 

4 Enter your business name (individual name if sole proprietor). 

Enter your address. 

Enter your city, state, and ZIP code. 
Form 11-C (Rev. 12-2012) Page 6 

Privacy Act and Paperwork Reduction 

Act Notice 

We ask for the information on Form 11-C to carry out the 

Internal Revenue laws of the United States. You are 

required to give us the information. We need it to ensure 

that you are complying with these laws and to allow us to 

figure and collect the right amount of tax. Section 4411 

imposes a special tax on each person who is engaged in 

receiving wagers for or on behalf of any person liable for 

the tax on wagers. Section 4412 requires that person to 

register with the IRS. Form 11-C is used to determine the 

amount of the tax you owe and to register certain 

information with the IRS. Section 6109 requires you to 

provide your identification number. Unless specifically 

prohibited by law, routine uses of this information include 

giving it to the Department of Justice for civil and criminal 

litigation; to cities, states, the District of Columbia, and 

U.S. commonwealths and possessions for use in 

administering their tax laws; to other countries under a 

tax treaty; to federal and state agencies to enforce federal 

nontax criminal laws; or to federal law enforcement and 

intelligence agencies to combat terrorism. If you fail to 

provide this information in a timely manner, you may be 

subject to penalties and interest. 

You are not required to provide the information 

requested on a form that is subject to the Paperwork 

Reduction Act unless the form displays a valid OMB 

control number. Books or records relating to a form or its 

instructions must be retained as long as their contents 

may become material in the administration of any Internal 

Revenue law. Generally, tax returns and return 

information are confidential, as required by section 6103. 

The time needed to complete and file this form will 

vary depending on individual circumstances. The 

estimated average time is: Recordkeeping, 3 hrs., 49 

min.; Learning about the law or the form, 57 min.; 

Preparing the form, 2 hrs., 0 min.; and Copying, 

assembling, and sending the form to the IRS, 16 min. 

If you have comments concerning the accuracy of 

these time estimates or suggestions for making this form 

simpler, we would be happy to hear from you. You can 

write to:

 Internal Revenue Service 

 Tax Products Coordinating Committee 

 SE:W:CAR:MP:T:M:S 

 IR-6526 

 1111 Constitution Ave. NW 

 Washington, DC 20224

Do not send the form to this address. Instead, see 

Where to file on page 3.