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

Expires 10-31-95 (Rev. November 1992)

Department of the Treasury

Internal Revenue Service

© See instructions on back.

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).) E Failure to furnish identifying number—section 6695(c)

A Understatements due to unrealistic positions—section 6694(a) F Failure to retain copy or list—section 6695(d)

G Failure to file a record of return preparers—section

6695(e)(1) Willful or reckless conduct (intentional disregard of rules and

regulations)—section 6694(b)

B

H Failure to include an item in the required record of

return preparers—section 6695(e)(2) Failure to furnish copy of return or claim for refund to taxpayer—

section 6695(a)

C

D Failure to sign return or claim for refund—section 6695(b) I Negotiation of check—section 6695(f)

2 Identification of Penalties (See Specific Instructions.)

(f)

Date paid

(mo., day, year)

(e)

Amount

paid

(d)

Amount

assessed

(c)

Kind of

penalty

(b)

Date of

statement

(a)

Statement document

locator number

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(j)

Tax

year

(i)

Form

involved

(h)

Taxpayer’s

identifying number

(g)

Taxpayer’s name

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

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

Under penalties of perjury, I declare that I 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. Cat No. 24415J Form 6118 (Rev. 11-92)
Form 6118 (Rev. 11-92) Page 2

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.

Paperwork Reduction Act Notice

We ask for the information on this form 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. You must file separate claims for a refund of each penalty

A, B, or I, even if you were charged two penalties of the

same type. The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Where and When To File

Recordkeeping 13 min. File Form 6118 with the IRS service center or IRS district

office that sent you the statement(s). Generally, your claim

must be filed within 3 years from the date you paid the

penalty.

Learning about the law or the form 11 min.

Preparing the form 8 min.

Copying, assembling, and sending

the form to the IRS 20 min. Specific Instructions 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 both the Internal Revenue Service, Washington, DC

20224, Attention: IRS Reports Clearance Officer, T:FP; and

the Office of Management and Budget, Paperwork

Reduction Project (1545-0240), Washington, DC 20503. DO

NOT send this form to either of these offices. Instead, see

Where and When To File on this page.

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 I) from item 1 to indicate the kind

of penalty on each line.

General Instructions

(Section references are to the Internal Revenue Code, unless

otherwise noted. )

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. Purpose of Form.—File Form 6118 if you are a tax return

preparer and want to claim a refund of preparer penalties you

paid but that 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.

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. If you need additional space, attach a

separate sheet.

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

single claim for:

1. Penalties G and H, provided you were billed for them on

the same statement. For additional information about refunds of preparer

penalties, see Regulations section 1.6696–1.

2. 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