rom 120 Quarterly Federal Excise Tax Return

(Rev. January 1992) Use To Report Excise Taxes for 1992. OMB No. 1545-0023
Department of the Treasury .
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[Part 1]
IRS No.| Environmental Taxes (Attach Form 6627 for all environmental taxes.) Tax IRS No.
53 Domestic petroleum superfund tax 53
18 Domestic petroleum oil spill tax 18
16 Imported petroleum products superfund tax 16
21 Imported petroleum products oil spill tax 21
54 Chemicals . : 54
17 Imported chemical substances . 17
19 Ozone-depleting chemicals . . 19
IRS No.| Communications and Air Transportation Taxes Tax IRS No.
Toll telephone service . ( Vi
22 Teletypewriter exchange service. 22
Local telephone service
26 Transportation of persons by air 26
28 Transportation of property by air 28
27 Use of international air travel facilities Pe ee _ 27
IRS No.) Fuel Taxes (Attach Form 8743 for all fuel taxes.) | Number of gallons Rate Tax IRS No.
60 Diesel fuel... ee $.201 60
71 Diesel fuel for use in trains _. we 026 71
78 Diesel fuel for use in certain intercity Buses. : _ 031 78
61 Special motor fuels. . . . . . 7... 141/.14 61
79 | Otheralcoholfuels. . . (See instructions.) 79
62 Gasoline... rrr 141 62
58 Gasoline sold for gasohol production eee ee .0966 58
59 Gasohol. . . . rere? 087 59
69 Aviation fuel (other than gasoline) . ee 176 69
14 Gasoline (noncommercial aviation)... eee 01 14
77 LUST tax on aviation fuel other than gasoline . . 001 77
IRS No.| Luxury Taxes (Attach Form 8807 for all luxury taxes) Tax IRS No.
92 Passenger vehicles . 92
90 Aircraft. 90
91 Boats 91
93 Furs . 93
94 | Jewelry . : 94
IRS No.| Retail Tax (Attach Form 8807) Tax IRS No.
33 Truck, trailer, and semitrailer chassis and bodies, and tractors we _ [ 33
IRS No.| Ship Passenger Tax Number of persons Rate Tax IRS No.
29__| Transportation by water... . $3 per person I 29

Cat. No. 10175Y

Form 720 (Rev. 1-92)


Form 720 (Rev. 1-92) Page 2

IRS No. Manufacturers Taxes Number of tons Sales price Rate Tax IRS No.
—36_| Coal—Underground mined $1.10 per ton 36
37 4.4% of sales price 37
—38_| Coal—Surface mined . $ .55 per ton 38
39 4.4% of sales price 39
66 Highway-type tires (See instructions)... woe 66
40 | Gas guzzler tax—Attach Form 6197... 7 se rer 40
IRS No. Number of doses Rate Tax IRS No.
81. | DPTvaccine. sw $4.56 81
82 | DT vaccings . we -06 82
83 | MMR vaccine... . 4.44 83
84 | Poliovaccine. . .29 84
IRS No.| Other Excise Taxes Premiums paid Rate Tax IRS No.
Y Policies issued by foreign insurers
Casualty insurance and indemnity bonds... $ .04 Vs
30 Life insurance. sickness and accident policies. and annuity contracts 01 30
Reinsurance. 2. 01
ARS No.| ‘Amount of obligations Rate Tax IRS No.
31 | Obligations not in registered form... $ .01 31
1 Total. Add all amounts in Part I. Attach Schedule A “unless one-time filing | . . . . Pm |$
IRS No. Tax IRS No.
41 Sport fishing equipment—Attach Form 8807... . ee 41
42_| Electric outboard motors and sonar devices—Attach Form. 8807. eee 42
44 | Bows and arrows—Attach Form 8807. ee 44
IRS No. Number of gallons Rate Tax IRS No.
64_| Inland waterways fuel use tax—Attach Form 8743. $ 151 64
51__| Alcohol sold as but not used as fuel (See instructions.) .54/.40 51
IRS No.| Floor Stocks Tax Tax IRS No.
20 Ozone-depleting chemicals (floor stocks)—Attach Form 6627... woe 20
2 Total. Add all amounts in Parti. a eS
3 Total tax. Add line 1, Part | and line 2, Part Il.
4 Adjustments (See instructions. Attach statement.) .
5 Tax as adjusted. woe
6 Taxes from line 1, Part! .
7 Adjustments to Part | taxes
8 Part | taxes as adjusted .
9 Taxes from line 2, Part Il
10 Adjustments to Part Il taxes
11 Part Il taxes as adjusted
12 Deposits you made for the quarter >
13 Overpayment from previous quarter . ad
14 Total deposits (add lines 12 and 13). i
15 BALANCE DUE. If line 5 is greater than line 14, enter the difference. This amount must be e paid
with the return .
16 OVERPAYMENT. If line 14 is greater ‘than line 5, ‘enter ‘the difference and check it you want it en os

O Applied to your next return, or_[] Refunded to you.

Under penalties of perjury. | declare that | have examined this return. including accompanying schedules and statements. and to the best of my knowledge
and beliet. it 1s true, correct. and complete,

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‘#U.S.GPO:1992-0-285-093