rom 6118 Claim of Income Tax Return Preparers

(Rev. July 1984)

Department of the Treasury > See instructions on back.

Internal Revenue Service

OMB No. 1545-0240
Expires 7-31-87

Name of preparer

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

Your social security number or employer

identification number

City or town, State, and ZIP code

‘Address shown on return(s) if different from above

Please Print or Type

IRS office that sent statement(s)

1 Kind of penalty (place letter in column 2(c)):
A. Negligent or intentional disregard of rules and regulations—6694(a)
B Willful understatement of liability —6694(b)
C Failure to furnish copy of return or claim for refund to taxpayer—6695(a)
D Failure to sign return or claim for refund —6695(b)

xromm

preparers—6695(e)(2)

Negotiation of check—6695(f)

Failure to furnish identification number—6695(c)
Failure to retain copy or list -6695(d)

Failure to file a record of return preparers—6695(e1)
Failure to include an item in the required record of return

2__ Identification of penalties claimed:

Statement document Date of Kind of
locator number statement penalty

(a) (b) (c)

Amount
assessed

(a)

Amount
paid
(e)

Date paid
(mo., day, year)
(fy

()

(2)

(3)

4)

(6)

(6)

Z)

(8)

(9)

(10)

(iy)

a2)

(13)

(14)

Taxpayer's name
@)

Taxpayer's
identifying number

(h)

Form
involved

10)

Taxable
year

@)

a)

(2)

@

(4)

(6)

(6)

@)

(C3)

(9)

(10)

ay

(2)

(13)

(14)

3 Amount to be refunded (total of column 2(e), lines (1) through (14))

>

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

belief they are true, correct, and complete.

Signature >

Date >

For Paperwork Reduction Act Notice, see back of form.

Form 6118 (Rev. 7-84)


Form 6118 (Rev. 7-84)

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 re-
quired to give us this information.

General Instructions
(Section references are to the Internal Revenue Code.)

If you feel you have overpaid preparer penalties, file Form
6118 to claim a refund of the overpayment. If you paid
more than one of the penalties listed in item 1 of Form
6118, you may have to file separate claims depending on
which kind of penalty you paid.

Claims for Refund of Penalties A, B, or |.—File a
separate claim on Form 6118 for penalties A, B, or |. If you
received statements of notice and demand for more than
one penalty, even though of the same kind, you must still
file a separate claim for each penalty. For example, if you
receive two statements assessing penalties under section
6695(f) for two different check negotiations, you must file a
separate claim for each penalty.

Claims for Refund of Penalties C, D, E, and F.—You
may list more than one of these penalties on one claim,
even if they are shown on more than one statement (that is,
you may list several penalties of any one kind or several
penalties of different kinds, or both), as long as the
penalties were imposed by the same office. You may not list
a penalty imposed by an IRS service center (shown on IRS
Form 5972, Income Tax Return Without a Preparer's
Signature, or Identificatiom Nunber or Both or TY-53 (Form
17), Statement of Tax Due IRS) and a penalty imposed by
an IRS district office (shown on IRS TY-26 (Form 17-A),
Statment of Tax Due IRS ) on the same claim. You may not
list penalties imposed by different service centers or district
offices on the same claim.

If you file one claim listing penalties that were shown on
more than one penalty statement, please list all of the
penalties from the same statement together. You do not
have to group the same penalty codes together.

Claims for Refund of Penalties G and H.—You can file
one claim for all penalties of these kinds, but only if the
penalties are shown on the same statement.

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

If you are employed or engaged by another preparer, or are
self-employed, enter your social security number. If you are
the employer of other preparers, enter your employer iden-
tification number.

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

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

You may want to attach a copy of the penalty state-
ment(s) to your claim.

In addition to completing the form, you must give your
reason(s) for claiming a refund for each penalty you have
listed. You may use the space below to do this. If you need
additional space, attach a separate sheet. Show each penal-
ty by line number and write your explanation next to it.

For additional information about refunds of preparer
penalties, see the regulations under section 6696.