Form 720 Quarterly Federal Excise Tax Return

(Rev. January 2009) OMB No. 1545-0023

Department of the Treasury

Internal Revenue Service

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

FOR IRS USE ONLY

Name Quarter ending

T

FF Number, street, and room or suite no. Employer identification number

(If you have a P.O. box, see the instructions.) FD

FP

City, state, and ZIP code. (If you have a foreign address, see the instructions.) I

T

Check here if:

Environmental Taxes (attach Form 6627) Tax IRS No.

Ozone-depleting chemicals (ODCs) 98

Communications and Air Transportation Taxes (see instructions) Tax

Local telephone service and teletypewriter exchange service 22

Transportation of persons by air 26

Transportation of property by air 28

Use of international air travel facilities 27

Fuel Taxes Number of gallons Rate Tax

60

.184

79

(b) Gasoline, tax on taxable events other than removal at terminal rack 62

.244

Aviation gasoline 14

Form 720 (Rev. 1-2009)

98

22

26

28

27

60

62

14

IRS No.

79 Other fuels (see instructions)

Cat. No. 10175Y

Part I

19 ODC tax on imported products 19

(a) Gasoline, tax on removal at terminal rack

.184

112 Liquefied petroleum gas (LPG) 112

(a) Diesel fuel, tax on removal at terminal rack

(b) Diesel fuel, tax on taxable events other than removal at terminal rack

$.244

.244

(c) Gasoline, tax on sale or removal of alcohol fuel

mixture other than removal at terminal rack

Final return

.194

35 35 (a) Kerosene, tax on removal at terminal rack (see instructions)

(b) Kerosene, tax on taxable events other than removal at terminal rack

.244

.244 %

%

%

Address change

Retail Tax

33 Truck, trailer, and semitrailer chassis and bodies, and tractors

Tax

33

Rate

12% of sales price

(c) Diesel fuel, tax on sale or removal of biodiesel mixture 

other than removal at terminal rack

.184

105 Dyed diesel fuel, LUST tax .001 105

107 Dyed kerosene, LUST tax .001 107

69 Kerosene for use in aviation (see instructions) .219 69

77 Kerosene for use in commercial aviation (other than foreign trade) .044 77

111 Kerosene for use in aviation, LUST tax on nontaxable uses .001 111

© See the Instructions for Form 720.

119 LUST tax, other exempt removals (see instructions) .001 119

104 Diesel-water fuel emulsion .198 104

Domestic petroleum oil spill tax 18

Imported petroleum products oil spill tax 21

18

21

.183

118 “P Series” fuels .184 118

120 Compressed natural gas (CNG) (GGE = 126.67 cu. ft.) .183 120

121 Liquefied hydrogen .184 121

Any liquid fuel derived from coal (including peat) through 

the Fischer-Tropsch process

122

.244 122

123 Liquid fuel derived from biomass .244 123

124 Liquefied natural gas (LNG) .243 124

Ship Passenger Tax Number of persons Rate Tax

29 Transportation by water $3 per person 29

Amount of obligations Rate Tax

31 Obligations not in registered form $ .01 31

Other Excise Tax
Form 720 (Rev. 1-2009) Page 2

Manufacturers Taxes Number of tons Sales price Rate Tax

$1.10 per ton 36 Coal—Underground mined 4.4% of sales price 37

$ .55 per ton 38 Coal—Surface mined

39

Taxable tires other than biasply or super single tires

Gas guzzler tax. Attach Form 6197. Check if one-time filing.

Vaccines (see instructions) 97

Foreign Insurance Taxes—Policies issued by foreign insurers Premiums paid Rate Tax

Casualty insurance and indemnity bonds $ .04

Life insurance, sickness and accident policies, and annuity contracts 30

Reinsurance

1

2

108

40

36

37

38

39

97

30

108

40

Floor Stocks Tax Tax

Total. Add all amounts in Part I. Complete Schedule A unless one-time filing ©

IRS No.

41 Sport fishing equipment (other than fishing rods and fishing poles)

Electric outboard motors

Bows, quivers, broadheads, and points

Inland waterways fuel use tax

Total. Add all amounts in Part II ©

Tax IRS No.

42

44

64

41

42

44

64

Number of gallons Rate Tax

4.4% of sales price

.01

.01

$ .20

$

$

20 Ozone-depleting chemicals (floor stocks). Attach Form 6627. 20

51 Alcohol and cellulosic biofuel sold as but not used as fuel 51

%

Part II

IRS No. IRS No.

Rate

10% of sales price

3% of sales price

11% of sales price

106 Arrow shafts $ .45 per shaft 106

114 Fishing tackle boxes 3% of sales price 114

117 Biodiesel sold as but not used as fuel 117

110 Fishing rods and fishing poles (limits apply, see instructions) 10% of sales price 110

109 Taxable biasply or super single tires (other than super single tires designed for steering) 109

113 Taxable tires, super single tires designed for steering 113

125 LUST tax on inland waterways fuel use (see instructions) .001 125

Total tax. Add line 1, Part I, and line 2, Part II ©

Claims (see instructions; complete Schedule C) 

3

4

5

6

7

10

11

Total of lines 5 and 6 ©

Balance Due. If line 3 is greater than line 9, enter the difference. Pay the full amount with the return(see instructions) ©

Overpayment. If line 9 is greater than line 3, enter the difference. Check if you want the

overpayment: Applied to your next return, or Refunded to you.

Deposits made for the quarter ©

Part III

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.

Sign

Here © Signature Date © Title

Type or print name below signature. Telephone number ( )

3

9

10

4

Overpayment from previous quarters ©

8

Enter the amount from Form 720X

included on line 6, if any ©

Designee

name ©

Third Do you want to allow another person to discuss this return with the IRS (see the instructions)?

Party

Designee

Phone

no. ©

Personal identification

( ) number (PIN) ©

Yes. Complete the following. No

5

6

7

8

9 Add lines 4 and 8 ©

11

Check here if you used the safe harbor

rule to make your deposits.

©

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

Number of tires Tax IRS No.

IRS No.
Note. You must complete Schedule A if you have a liability for any tax in Part I of Form 720. Do not complete Schedule A

for Part II taxes or for a one-time filing of the gas guzzler tax.

1 Regular method taxes

(a)

First month A

Second month C

Third month E

Period

1st–15th day 16th–last day

B

D

F

(b) Net liability for regular method taxes. Add the amounts for each semimonthly period.

2 Alternative method taxes (IRS Nos. 22, 26, 28, and 27)

M

O

Q

Period

1st–15th day 16th–last day

N

P

R

(b) Alternative method taxes. Add the amounts for each semimonthly period.

Record of Net

Tax Liability

(a) Record of Taxes

Considered as

Collected

First month

Second month

Third month

Form 720 (Rev. 1-2009) Page 3

Schedule A Excise Tax Liability (see instructions)

Special rule for September* ©

Special rule for September* ©

Form 720 (Rev. 1-2009)

G

S

Schedule T Two-Party Exchange Information Reporting (see instructions)

Fuel Number of gallons

Diesel fuel, gallons received in a two-party exchange within a terminal, included 

on IRS No. 60(a) on Form 720

Diesel fuel, gallons delivered in a two-party exchange within a terminal

Kerosene, gallons received in a two-party exchange within a terminal, included on IRS No. 35(a),

69, 77, or 111 on Form 720

Kerosene, gallons delivered in a two-party exchange within a terminal

Gasoline, gallons received in a two-party exchange within a terminal, included on IRS No. 62(a)

on Form 720

Gasoline, gallons delivered in a two-party exchange within a terminal

Aviation gasoline, gallons received in a two-party exchange within a terminal,

included on IRS No. 14 on Form 720

Aviation gasoline, gallons delivered in a two-party exchange within a terminal

*Complete only as instructed. See the instructions.
Form 720 (Rev. 1-2009) Page 4

Schedule C Claims

1

3

Nontaxable Use of Gasoline

Rate Gallons Amount of claim

Gasoline (see Caution above line 1) $.183 362

Nontaxable Use of Undyed Diesel Fuel

Rate Gallons

$.243

5

b 353

a

c

Nontaxable use

CRN

Amount of claim CRN

Period of claim ©

Month your income tax year ends ©

Period of claim ©

Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Use in trains .243

● Complete Schedule C for claims only if you are reporting liability in Part I or II of Form 720.

● Attach a statement explaining each claim as required. Include your name and EIN on the statement. See the instructions.

2 Nontaxable Use of Aviation Gasoline

Kerosene Used in Aviation (see Caution above line 1)

Other nontaxable use (see Caution above line 1)

a Used in commercial aviation (other than foreign trade) $.15

b .193

Rate Gallons Amount of claim CRN

Rate Gallons Amount of claim CRN

Period of claim ©

Period of claim ©

Use in certain intercity and local buses (see Caution above line 1) .17

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed

explanation and check here ©

Form 720 (Rev. 1-2009)

4 Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)

Rate Gallons

Nontaxable use $.243

Amount of claim CRN

Period of claim ©

Claimant certifies that the kerosene did not contain visible evidence of dye.

Caution. Claims cannot be made on line 4 for kerosene sales from a blocked pump.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed

explanation and check here ©

354

324

350

360

346

346

Type of use

Type of use

Type of use

Type of use

Caution. Claimant has the name and address of the person(s) who sold the fuel to the claimant, the dates of purchase, and if

exported, the required proof of export. For claims on lines 1a and 2b (type of use 13 and 14), 3c, 4b, and 5, claimant has not waived 

the right to make the claim.

a

b Use in certain intercity and local buses (see Caution above line 1) .17 347

$

$

$

c Use on a farm for farming purposes .243 346

d Use on a farm for farming purposes .243 360

Kerosene used in commercial aviation (other than foreign trade)

taxed at $.219

b

Nontaxable use (other than use by state or local government)

taxed at $.244

c

.175

.243

$

a

b Exported (see Caution above line 1) .184 411

c Exported (see Caution above line 1) .194 412

e Exported (see Caution above line 1) .244 413

d Exported (see Caution above line 1) .244 414

355

Type of use

Kerosene used in commercial aviation (other than foreign

trade) taxed at $.244

a

$.200 417

369

d

.218

Nontaxable use (other than use by state or local government)

taxed at $.219

$

d LUST tax on aviation fuels used in foreign trade .001 433

e Nontaxable use taxed at $.044 .043 377

f Nontaxable use taxed at $.219 .218 369

e LUST tax on aviation fuels used in foreign trade .001 433
Liquefied petroleum gas (LPG)

Nontaxable Use of Alternative Fuel

“P Series” fuels

a

b

c Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)

Rate Amount of claim CRN

419

Type of use

$.183 $

.183

.183

Liquefied hydrogen

Any liquid fuel derived from coal (including peat) through

the Fischer-Tropsch process

d

e

f Liquid fuel derived from biomass

g Liquefied natural gas (LNG)

.183

.243

.243

.243

420

421

422

423

424

425

Gallons or gasoline

gallon equivalents

(GGE)

6

Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See the Instructions for

Form 720 for the credit rate.

Form 720 (Rev. 1-2009) Page 5

7 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Rate Gallons

360

b

a Use by a state or local government $.243

Amount of claim CRN

Period of claim ©

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed

explanation and check here ©

Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained

written consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Registration Number ©

Use in certain intercity and local buses .17

8 Sales by Registered Ultimate Vendors of Undyed Kerosene

(Other Than Kerosene For Use in Aviation)

Period of claim ©

Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the

written consent of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.

Registration Number ©

Rate Gallons

346 b

a Use by a state or local government

Amount of claim CRN

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed

explanation and check here ©

c

Sales from a blocked pump

$.243

350

Use in certain intercity and local buses .17 347

$

.243

$

9 Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

b

a Use in commercial aviation (other than foreign trade) taxed at $.219

Use in commercial aviation (other than foreign trade) taxed at $.244

Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the

buyer, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to make the claim. See the

instructions for additional information to be submitted.

Registration Number ©

Type of use Rate Gallons Amount of claim CRN

.200

$.175 355

d

c Nonexempt use in noncommercial aviation

Other nontaxable uses taxed at $.244 .243 346

.025

10 Sales by Registered Ultimate Vendors of Gasoline

b

a Use by a nonprofit educational organization

Use by a state or local government

Rate Gallons Amount of claim CRN

.183

362 $.183

Claimant sold the gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the

amount of tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired

certificate from the buyer and has no reason to believe any information in the certificate is false. See the instructions for

additional information to be submitted.

$

Registration Number ©

e Other nontaxable uses taxed at $.219 .218

417

418

369

f LUST tax on aviation fuels used in foreign trade .001 433

Form 720 (Rev. 1-2009)

$

h Liquefied gas derived from biomass .183 435
Form 720 (Rev. 1-2009) Page 6

Sales by Registered Ultimate Vendors of Aviation Gasoline

Claimant sold the aviation gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of

tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired certificate from the buyer and

has no reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.

11 Registration Number ©

b

a Use by a nonprofit educational organization

Use by a state or local government

324

Rate Gallons Amount of claim CRN

$

.193

$.193

Biodiesel or Renewable Diesel Mixture Credit

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM D6751 and met

EPA’s registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the

claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller. Renewable diesel mixtures. Claimant

produced a mixture by mixing renewable diesel with liquid fuel (other than renewable diesel). The renewable diesel used to produce the renewable diesel

mixture was derived from biomass, met EPA’s registration requirements for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard

approved by the IRS. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the

Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller, both of which have been edited as discussed in the instructions for line 13. See the

instructions for line 13 for information about renewable diesel used in aviation.

13 Registration Number ©

b

a Biodiesel (other than agri-biodiesel) mixtures

Agri-biodiesel mixtures

Rate Gal. of Biodiesel or

Renewable Diesel Amount of claim CRN

1.00

$1.00

390

388

Period of Claim ©

$

c Renewable diesel mixtures 1.00 307

Alcohol Fuel Mixture Credit

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any

person for use as a fuel or was used as a fuel by the claimant. See Line 12. Alcohol Fuel Mixture Credit in the Instructions for Form 720.

12 Registration Number ©

b

a Alcohol fuel mixtures containing ethanol

Alcohol fuel mixtures containing alcohol (other than ethanol)

Rate Gal. of Alcohol Amount of claim CRN

394

393

.60

$.45

Period of Claim ©

$

Total claims. Add all amounts on lines 1–15. Enter the result here and on page 2, Part III, line 4 of Form 720. 16

Amount of claim CRN

16

15 Other claims. See the instructions. For lines 15b and 15c, see the Caution above line 1 on page 4.

a Section 4051(d) tire credit (tax on vehicle reported on IRS No. 33)

b

366

c

$

Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001

d Diesel-water fuel emulsion

e Registered credit card issuers

Exported dyed kerosene

f

415

416

14 Alternative Fuel Credit and Alternative Fuel Mixture Credit

Liquefied petroleum gas (LPG)

“P Series” fuels

a

b

426

427

Registration Number ©

Rate

Gallons or

gasoline gallon

equivalents (GGE)

(see instructions)

Amount of claim CRN

$.50 $

Compressed natural gas (CNG) (GGE = 121 cu. ft.)

Liquefied hydrogen

c

d

Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process

Liquid fuel derived from biomass

e

f

g Liquefied natural gas (LNG)

.50

.50

.50

.50

.50

428

429

430

431

432

g

h

j

For the alternative fuel mixture credit, claimant produced a mixture by mixing taxable fuel with alternative fuel. Claimant certifies that it (a)

produced the alternative fuel, or (b) has in its possession the name, address, and EIN of the person(s) that sold the alternative fuel to the

claimant; the date of purchase; and an invoice or other documentation identifying the amount of the alternative fuel. The claimant also

certifies that it made no other claim for the amount of the alternative fuel, or has repaid the amount to the government. The alternative fuel

mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant.

.50

h Liquefied gas derived from biomass .50 436

i Compressed gas derived from biomass (GGE = 121 cu. ft.) .50 437

Taxable tires other than biasply or super single tires

Taxable tires, biasply or super single tires (other than super single tires designed for steering)

Taxable tires, super single tires designed for steering

Number of tires Amount of claim CRN

$

i

k

396

304

305
Form 720-V,

Payment Voucher

Purpose of Form

Complete Form 720-V if you are making a payment by

check or money order with Form 720, Quarterly

Federal Excise Tax Return. We will use the completed

voucher 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, you may apply for

one online. Go to the IRS website at

www.irs.gov/businesses/small and click on the

“Employer ID Numbers (EIN)” 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. However, if you are

making a one-time filing, enter your social security

number.

● Enclose your check or money order made payable to

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

(SSN for one-time filing), “Form 720,” and the tax

period on your check or money order. Do not send

cash. Do not staple this voucher or your payment to

the return (or to each other).

● Detach the completed voucher and send it with your

payment and Form 720. See Where To File on page 2

of the Instructions for Form 720.

If you have your return prepared by a third party and

a payment is required, provide this payment voucher to

the return preparer.

Box 3. Darken the capsule identifying the quarter for

which the payment is made. Darken only one capsule.

Box 4. Enter your name and address as shown on

Form 720.

Box 2. Enter the amount paid from line 10 of

Form 720.

1st

Quarter

2nd

Quarter

3rd

Quarter

4th

Quarter

Enter the amount of your payment. ©

2

Ä Detach Here and Mail With Your Payment and Form 720.

OMB No. 1545-0023 720-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

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

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

Enter your address.

Enter your city, state, and ZIP code.

Form 720-V (2009)

Dollars Cents

Do not file Form 720-V if you are paying the balance

due on line 10 of Form 720 using EFTPS.

Ä

3 Tax period

Enter your employer identification

number.

1

(77) 2009