Form 11-C Occupational Tax and Registration Return for Wagering

(Rev. April 2008) OMB No. 1545-0236

Department of the Treasury Return for period from , to June 30, Internal Revenue Service (Month and day)

Name

Type 

or 

Print

Number, street, and room or suite no.

Employer identification number

City, state, and ZIP code

Check one: First return Renewal return

For IRS Use Only

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

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

T $ 1

FF 2

Alias, style, or trade name, if any FP 3

I 4

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.

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. 4-2008)

Part I

Part II

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

(Year) (Year)

Daytime telephone number

( )
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

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.

Part IV

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

Supplemental Registration (see instructions)

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

Sign

Here © Signature Date © Title

Form 11-C (Rev. 4-2008) Page 2

Date Preparer’s SSN or PTIN

Preparer’s Paid signature

Preparer’s 

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code Phone no. ( )

©

© EIN

Check

if selfemployed

Form 11-C (Rev. 4-2008)
Form 11-C (Rev. 4-2008) Page 3

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.

Section references are to the Internal Revenue Code

unless otherwise noted.

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 the instructions for Line 2 to

determine your occupational tax. Your cancelled check

is proof of registration and payment.

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

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

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.

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.

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.

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, 2008 or

2009).

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.

Department of the Treasury

Internal Revenue Service

Cincinnati, OH 45999-0101

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

state-conducted 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.

● 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.

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.

Definitions. See the Instructions for Form 730 for the

definition of sports event, contest, wagering pool, and

lottery.

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.

General Instructions
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.

If you start

accepting

wagers in

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

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,

Monthly Tax Return for Wagers.

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.

$500

tax

$50

tax

Supplemental Registration

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.

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.

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.

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

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

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.

Form 11-C (Rev. 4-2008) 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.
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.

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.

● 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.

If you have your return prepared by a third party,

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

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, 2008, enter 200807.

Box 4. Enter your name and address as shown on

Form 11-C.

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

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

Y

Enter the amount of your payment. ©

2

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

OMB No. 1545-0235

Form 11-C(V)

Department of the Treasury

Internal Revenue Service

Payment Voucher

Enter your employer identification

number.

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

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

Enter your address.

Enter your city, state, and ZIP code.

1 Dollars Cents

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

(Rev. April 2008)
Form 11-C (Rev. 4-2008) Page 6

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, and the District of Columbia 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.

The time needed to complete and file this form will

vary depending on individual circumstances. The

estimated average time is: Recordkeeping, 7 hr., 24

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

Preparing the form, 2 hr., 3 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 the Internal Revenue Service, Tax

Products Coordinating Committee,

SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,

IR-6526, Washington, DC 20224. Do not send the form

to this address. Instead, see Where to file on page 3.

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.

Privacy Act and Paperwork

Reduction Act Notice