rom 6118 Claim of Income Tax Return Preparers OMB No. 1545-0240

(Rev. February 1990)

Expires 1-31-93

Department of the Treasury > See instructions on back.

Internal Revenue Service

‘Name of preparer

Identifying number (See instructions.)

‘Address to which statement(s) of notice and demand were mailed

City or town, state, and ZIP code.

‘Address of IRS office that sent statement(s)

‘Address shown on return(s) for which penalties were assessed (if different from above)

Please Print or Type

1 Kind of Penalty (Enter letter in column 2(c).)

A Understatements due to unrealistic positions (Negligent or intentional
disregard of rules and regulations) —section 6694(a)

B Willful or reckless conduct (Willful understatement of liability) —
section 6694(b)

C Failure to furnish copy of return or claim for refund to taxpayer—
section 6695(a)

D Failure to sign return or claim for reftund—section 6695(b)

Failure to furnish identifying number—section 6695(c)
Failure to retain copy or list—section 6695(¢)

Failure to file a record of return preparers—
section 6695(e)(1)

Failure to include an item in the required record of
return preparers—section 6695(e)(2)

1 Negotiation of check—section 6695(f)

xz AmMm

2__ Identification of Penalties (See Specific Instructions.)

(a) (b) (c)
Statement document Date of Kind of
locator number statement penaity

(a) (e) (f
Amount Amount Date paid
assessed paid (mo., day, year)

@)

(2)

Q) —

(4) —

OO)
(6)

2)

(8)

(2).

(20)

(1)

(12)

(13)

(14)

(e)

(hy 10) w@
Taxpayer's Form Tax

Taxpayer's name identifying number involved year

()

@)

(3)

(4)

(5)

6)

@)

@& _

(9)

(1Q)

(i)

G2)

(3)

(14)

3 Amount To Be Refunded (total of column 2(e), lines (1) through (14))

ad

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

and belief, it is true, correct, and complete.

Signature >

Date >

For Paperwork Reduction Act Notice, see back of form.

Form 6118 (Rev. 2-90)


Form 6118 (Rev. 2-90)

Page 2

Paperwork Reduction Act Notice
We ask for this information to carry out the Internal
Revenue laws of the United States. We need it to ensure
that taxpayers are complying with these laws and to allow
us to figure and collect the right amount of tax. You are
required to give us this information.

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is:

Recordkeeping . -13 min.
Learning about the law or the form. . 11min.
Preparing the form woe ee es Bmin.
Copying, assembling, 2 and d sending

theformtoIRS . . . -20 min.

If you have comments concerning the accuracy of these
time estimates or suggestions for making this form more
simple, we would be happy to hear from you. You can write
to the Internal Revenue Service, Washington, DC 20224,
Attention: IRS Reports Clearance Officer, T:FP; or the
Office of Management and Budget, Paperwork Reduction
Project (1545-0240), Washington, DC 20503.

General Instructions

(Section references are to the Internal Revenue Code,
unless otherwise noted.)

Purpose of Form.—File Form 6118 if you are a tax return
preparer and want to claim a refund of preparer penalties
you believe were incorrectly charged.

Claims for More than One Penalty.—if you are claiming a
refund for more than one of the penalties listed in item 1 on
this form, you may or may not be able to claim them on the
same form depending on the type of penalty involved.

You may claim a refund for more than one penalty on a
single claim:

(1) For penalties G and H, provided you were billed for
them on the same statement.

(2) For penalties C, D, E, and F, even if you were billed
for them on different statements. However, the penalties
must all have been imposed by the same IRS office. You

may not list penalties imposed by an IRS service center
(shown on Form 6335) and penalties imposed by a district
office on the same claim. If you file a single claim for
penalties billed on different statements, please group the
penalties from each statement together.

You must file separate claims for a refund of each
penalty A, B, or |, even if you were charged two penalties of
the same type.

Where and When To File

File Form 6118 with the IRS service center or IRS district
office that sent you the statement. Generally your claim
must be filed within 3 years from the date you paid the
penalty.

Specific Instructions

Identifying Number.—If you are self-employed or
employed by another preparer, enter your social security
number. If you are the employer of other preparers, enter
your employer identification number.

Items 2 and 3.—Be sure to enter the document locator
number (DLN) and the date from each penalty statement
you received in columns 2(a) and 2(b) of the form. In
column 2(c) show the letter (A through |) from item 1 to
indicate the kind of penalty on each line.

Fill in columns 2(d) and 2(g) through 2(j) using the
information shown on the statements. Then fill in columns
2(e) and 2(f) and item 3 showing the amount of each
penalty, the date you paid it, and the total amount you are
claiming as a refund.

Additional Information. —You may want to attach a copy
of the penalty statements to your claim.

In addition to completing the form, you must give your
reasons for claiming a refund for each penalty you have
listed. Identify each penalty by its line number from item 2,
and write your explanation next to it. You may use the
space below to do this. !f you need additional space, attach
a separate sheet.

For additional information about refunds of preparer
penalties, see Regulations section 1.6696-1.

U.S. Government Printing Office: 1990-262-151/00075