Inland Waterway Fuel

In addition to the tax on special motor fuel used ina
motorboat, there is an 8¢-a-gallon excise tax imposed on
the use of any liquid used as a fuel in vessels for
‘commercial transportation on the inland waterways. See
Publication 510 for more information.

Aviation fuel. —A taxis imposed on aviation fuel
sold for use or used in noncommercial aviation. The
retailers tax on aviation gasoline is in addition to the
manufacturers tax. If fuel was taxed on its sale as a
special motor fuel but subsequently itis used as aviation
fuel, the tax on the user would be the difference
between the 146 rate and the rate previously paid on the
sale of the fuel to the user. There 1s no retail tax on
gasohol or other alcohol fuel used in noncommercial
aviation.

Gasohol and other Alcohol Fuels

The sale of gasohol by a producer of gasoline 1s
taxable at 4¢ a gallon. The sale of gasoline for use in
manufacturing gasohol is taxable at 4¢ a gallon. To
qualify, the gasohol must contain at least 10% alcohol
that is at least 190 proof.

If you plan to make gasohol, using specially denatured
alcohol, you must first get a permit from the Bureau of
‘Alcohol, Tobacco, and Firearms.

‘Anyone who separates the gasoline or motor fuel from
an alcohol mixture which has been taxed at the 4¢ rate
will be subject to the additional 5¢ a gallon excise tax on
the separated fuels.

The tax on gasohol and other alcohol fuels is reported
‘on Form 720 on the line for IRS No. 61 or 62.

Crude Oil Windfall Profit Tax

‘The tax on windfall profit is computed on Form
6047, Windfall Profit Tax, which must be attached to
Form 720 on a quarterly basis by the purchasers,
qualified disbursers, operators, and certain producers.

Producers will receive Form 6248, Annual
Information Return of Windfall Profit Tax, from their
purchasers at the end of each year. The form shows total
tax liability, tax paid by purchaser, and the amount of
any tax underwithheld or overwithheld.

if the tax was underwithheld, the producer must file
Form 720 to report and pay the balance due on the first
quarter return, by May 31. This amount should be
entered in the space marked ‘Annual return’ on the line
for IRS No. 52 and the social security number of the
producer should be entered in the space to the right of
IRS No. 52. If tax was overwithheld, see Form 6249,
Computation of Overpaid Windfall Profit Tax.

Environmental Taxes

The tax rates for the environmental taxes are shown
‘on Form 6627, Environmental Taxes. Form 6627 is
used to compute the liability for these taxes and must be
attached to Form 720 each quarter.

Line 2, Adjustments. — Generally, you may make
adjustments for taxes reported on Form 720 (1) to
correct mathematical errors, or (2) to adjust payments.
of tax on transactions, charges, or processings that are
entitled to be made tax-free.

On line 2, enter the total of any adjustments claimed.
Attach a statement that includes the following:

(@) An explanation of why you are claiming a
reduction in tax.

(b) Astatement that you have the required
‘supporting evidence.

The IRS Numbers being adjusted.
The amount of adjustment claimed for each.

The period in which the tax liability was
previously reported.

€
@
e

Page 4

See the applicable regulations and Publication 510
for the circumstances under which you may make
adjustments and the evidence you need to support
adjustments.

Line 4, Record of Federal Tax Liability.—You must
deposit all excise taxes over $100 reportable on Form
720 at an authorized depositary or the Federal Reserve
Bank (FRB) serving the area in which you are located.

To avoid a penalty, do not mail your deposits directly
tothe IRS. Records of your deposits will be sent to IRS.
for crediting to your business account(s)..

Deposit Federal excise tax payments with a Federal
Tax Deposit Payment Coupon (Form 8109). See the
instructions in the coupon book for additional
information and exceptions.

There will no longer be periodic mailouts of FTD
deposit forms. To get more deposit forms, use the
reorder form (Form 8109A) provided in the coupon
book. Be sure to enter the number of books you need.
There are 15 coupons to a book for use in depositing any
kind of tax for any tax year. If you do not have a coupon.
book, please request one from your IRS district office.

The following rules explain how often you must make
deposits for excise taxes other than windfall profit taxes
or inland waterway taxes. (For special rules on
depositing windfall profit taxes, see the instructions
for Form 6047.) No deposits are required for the inland
waterway tax. The tax is payable with the return.

In general, the frequency of deposits is based on the
amount of tax you owe for a certain period. You must
make deposits monthly or semimonthly, as explained
below.

Monthly deposits. —You must make monthly
deposits if—You are liable in any month (except the last
month of the quarter) for more than $100 of taxes
reportable on Form 720, AND you are not required to
make semimonthly deposits (see below).

Monthly deposits are due by the last day of the
month following the month you incur more than $100
liability.

It you owe taxes of $100 or less at the end of the first
‘or second month, carry them over to the next month. At
the end of the third month, taxes of $100 or less may be
deposited or paid with the return.

If you owe taxes of more than $100 at the end of the
third month, you must deposit them by the last day of
the following month.

For air transportation and communications taxes, the
tax that is computed on the basis of amounts billed
(communications) or tickets sold (air transportation) for
a month is considered collected during the next month
and should be deposited during the month following the
month it is considered collected.

‘Semimonthly deposits. —If you are liable for over
$2,000 of excise tax for any month of a quarter, you
must make semimonthly deposits of taxes in the
following quarter. (A “'semimonthly"’ period means the
first 15 days of a month or the 16th through the last day
of a month.)

The rules for making semimonthly deposits are as
follows:

(A) In general: Deposit the amount you owe by the
9th day following the semimonthly period for which itis
reported.

(B) Air transportation and communications taxes: If
the amount for these taxes is computed on the basis of
amount billed (communications) or tickets sold (air
transportation), the tax computed for a semimonthly
period 1s considered as collected during the second
following semimonthly period. Deposit these taxes within
3 banking days after the end of the semimonthly period
for which it is considered collected.

If the tax is computed on any other basis, deposit the
taxes within 3 banking days after the end of the
semimonthly period in which it was collected. In
determining banking days, do not count local banking
holidays observed by depositaries or Saturdays,
‘Sundays, and legal holidays.

(C) Gasoline taxes: Qualified persons whose liability
for the manufacturers excise tax on gasoline is payable
semimonthly may pay the tax by the 14th day after the
close of the semimonthly period if the payment is made
toany authonzed government depositary.

A “qualified person’” is any person whose average
daily production of crude oil for the preceding calendar
quarter is 1,000 barrels or less and any independent
refiner as defined in section 4995(b)(4) of the Internal
Revenue Code

If the due date falls on a Saturday, Sunday, or a
holiday in the District of Columbia, the due date shall be
the immediately preceding day which ts not a Saturday,
Sunday, or such a holiday.

(D) Policies issued by foreign insurers: If the amount
of tax on these policies is for the first semimonthly
period, deposit it by the 1st day of the next month. If the
amount is for the second semimonthly period, deposit it
by the 15th day of the next month.

Exceptions.—You are considered to meet the
semimonthly deposit requirements if the amount you
deposit for the semimonthly period is one of the
following:

(1) At least 90% of the total tax collected during (or
reportable for) the semimonthly period.

(2) At least 45% of the total tax collected during (or
reportable for) the month.

(3) At least 50% of the total tax collected during (or
reportable for) the second preceding month (first
preceding month for air transportation and
communications).

(4) Manufacturers and retailers taxes: An amount
deposited for the second semimonthly period in a month
that, when added to the deposit for the first
semimonthly period, 1s at least 90% of the total taxes
reportable for the month.

If you claim one of the exceptions, please check the
appropriate box on page 1

In addition, if the semimonthly period is in either of
the first 2 months of the quarter, you must deposit the
underpayment for the month by the following dates:

(a) Tax on foreign insurances policies—The first day
of the second month following the month involved

(b) Manufacturers and retailers taxes—The ninth
day of the second month following the month involved.

(©) Air transportation and communications—The last
day of the month following the month involved.

Notes:

(1) if you meet the semimonthly deposit exception
under (2), (3), or (4) above, you may be exempt from
certain recordkeeping requirements. You may not have
to—

(a) Keep books and records on a semimonthly
basis (except for deposits), or

(b) Record your tax liability on a semimonthly_
basis in line 4. See regulations sections
48.6302(c)-1 and 49.6302(c)-1

(2) You do not meet the requirements under (2) or
(3) above if you collect more than 75% of air
transportation or communications taxes (or incur more
‘than 75% of the monthly liability for other taxes) in the
first semimonthly period in each month,

Notes on making deposits:

1. If you are paying a tax for the first time or you need
more forms, contact the District Director or the Director
of the Service Center for your area in time to make the
required deposits. (See "Where to File”.) Send any tax
due and not deposited along with the return. For more
information, see Publication 583.

2. The above provisions do not extend the time for
depositing taxes for the last semimonthly period of the
‘quarter. Nor do they remove penalties for failure to
make other required deposits on time.

Lines 5 and 8, Overpayment.—if you deposited
more than the amount you owed for a quarter, you may
have the overpayment applied to your next return or
tefunded to you. Enter the appropriate amount in the
space on line 8. Enter on line 5 of your next return any
amount you want to have applied to your next return.


rom 120

(Rev. October 1983)

Department of the Treasury—Internal Revenue Service

Quarterly Federal Excise Tax Return

> For Paperwork Reduction Act Notice, see instructions.

ome

545-0023

Use to Report Excise
Taxes for 1983 and the
Floor Stock Tax on Tires

Please enter - T
your name, Quarter ending F
address,
employer FD
identificatic
number, nd. Employer identification number FP
calendar t
quarter of T
return, if
not preprinted. If address is
(If not different from
correctly — —_ prior return,
viease change.) Note: Be sure to enter the tax on the correct line to insure proper credit. checkhere >
PART |.—Computation of Tax Items PART I1.—Computation of Net Tax Liability
Facilities and Services Rate Tax RS 1 Total tax. Add all amounts from Part | $
Toll telephone service 2 Adjustments. (See instructions, Attach
Teletypewriter exchange service 3% 22 statement.)
Locat telephone service . 3  Taxas adjusted .....Ls
Transportation of persons by air 8% 26 |_4 (a) Record of Tax Liability. (See instructions on page 4.)
Use of international air travel facilities . $3.00 per 27 Period Amount of Liability
Transportation of property by air . 5% 28 Ast-15th day
* First “17 6th-last d
Policies issued by foreign insurers . e) 30 | Month ast day
Obligations not in registered form .. *) 31 Total for month
Manufacturers 1st-15th day ——|
Second | Gti last d —
Coal (1 ton = 2,000 Ibs.): SS Month last day’
a Underground mined @ $1.00 per ton oo 36 Total for month SSS [
*) 7 Ist-15th day
b Underground mined @ 4% of ton price 37 | shied ae
¢ Surface mined @ 50¢ per ton =——| 38 | Month y
d Surface mined @ 4% of ton price (*) 39 Total for month
Fishing rods, and artificial lures, etc. . 10% 4. (b) Total liability for quarter
Bows and arrows. . 11% 44 (c) Total deposits for quarter
Pistols and revolvers... . 10% 32 | 5 Overpayment from previous quarter. >
Firearms (other than pistols and revolvers) . 11% 46 | 6 Total deposits (item 4(c) plus item 5) >
Shells and cartridges 11% 49 | 7 Undeposited taxes due (item 3 less item
Gasoline (manufacturers tax) . “ 62 6; this should be $100 or less). Pay to
Alcohol sold as but not used as fuel (*) 51 Internal Revenue Service... 2
1 highway vehicle type. 9.75¢ Ib. Note: If undeposited taxes due at the end of the quarter are more
Wes {laminated .  . i¢ Ib. 66 than $100 the entire balance must be deposited.
Floor stock-tires motes 57 If you make semimonthly deposits and claim one of the deposit
. exceptions, please indicate the exception:
Inner tubes a 67
Tread rubber (camelback) . 68 10 20 30 40
Fuel economy 40 Gasoline producers or refiners who are eligible for the 14-day
Retall and Use Taxes depositary due date, please check this box. & CL]
Truck and trailer chassis and bodies; tractors 12% (*) 33 | 8 IfitemGis more thanitem 3, enterexcesshere mB $
Diesel fuel and special motor fuels. (*) 61 and check if you want it: [1] applied to your next return, or
Inlandwaterwayfuel . . . . . | 8¢gal. 64 O tretunded to you.
Fuel used in Fuel other 14¢ gal. (*) 69 ] 9 Ifnotliable for returns in succeeding quarters, write “FINAL”
noncommercial } than gasoline
aviation Gasoline (retailers tax) 3¢ gal. (*) 14 here >
Crude Oil Windfall Profit Tax and return this form to your internal Revenue Service Center.
Quarterly return (Attach Form 6047) (*) 50
Annualreturn . . se ee °) 52 |_ Social security number for IRS No. 52 >
Environmental Taxes
Petroleum (Attach Form 6627) “) 53
Chemicals (Attach Form 6627) *) 54
Hazardous wastes (Attach Form
6627)... . : 55

*See instructions on pages 2 and 4.

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

Signature >

Title (Owner, etc.) >

Date >



General Instructions

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 required to give
us this information.

Purpose of Form.—Use this form to report and pay
the excise taxes listed on page 1. You must file a return
for each quarter even if you do not owe any tax. (If you
have no tax to report, write "None" on lines 1 and 3.)
For more information get Publication 510, Excise Taxes
for 1983.

Exemptions. —Some transactions are exempt from
tax. For example, export transactions and transactions
involving States, political subdivisions, certain nonprofit
educational organizations, certain aircraft museums,
and certain helicopter usage, are exempt. Indian tribes,
when exercising an essential tribal government function,
are considered States and are exempt

Records.—Keep copies of your tax return, records,
and accounts of all transactions to show that the correct
tax has been paid. Keep records to support all
zdjustments claimed and all exemptions at least 4 years
from the latest of the following dates: (1) when the tax
became due, (2) when you paid the tax, (3) when you
claimed an adjustment, or (4) when you filed a claim for
a refund. Your records must be available at all times for
IRS inspection.

Penalties and Interest.— Avoid penalties and interest
by filing returns and depositing and paying taxes when
due. The law provides penalties for:

* Filing return late, 5% of the tax per month, or
part of a month, the return is late (maximum 25%).

‘© Depositing taxes late, 5% of the underpayment.
© Overstating deposits, 25% of the overstatement.

* Paying taxes late, 1/2 of 1% of the unpaid amount
for each month or part of a month it remains
unpaid—up to 25% of the unpaid amount. The penalty
applies to unpaid tax shown on a return and to any part
‘of additional tax shown on a bill if itis not paid within 10
days from the date of the bill.

If you can show reasonable cause for late filing, late
payment, or not depositing the proper amount of tax
when due, the penalty does not apply. If you are late
filing a return or depositing taxes, send in a full
explanation with the return.

© Wilifully failing to collect and pay tax, keep
records, or file return, 100%.

Filing false or fraudulent returns, 50% of the
underpayment plus 50% of the interest attributable to
the underpayment.

These penalties are in addition to the interest charge
on late payments.

Also, be sure to sign the return. An unsigned return is,
not considered filed

When to File. —You must file a return for each
quarter of the calendar year as follows.

Where to Fi
ityour principal business, office

Fite with the Internal

or agency, or legal residence Revenue Service
in the case of an individual, Center at
is located in

Quarter covered | trans., comm., an
windfall profit
ue

January, February,
March. April30.. May 31
‘April, May, June July 31 ‘August 31
July, August,

September October31. . | November30
October, November,

jecember.. . | January 31 February 28

For excise taxes other than those on air
transportation, communications, or windfall profits you
‘may have an additional 10 days to file your return if it
shows that you have made deposits of the taxes due for
‘the quarter on time and in full

If you are reporting two or more excise taxes, and
they are due on different dates, the later filing date will

be acceptable providing timely deposits were made. Only
‘one return should be filed each quarter.

Page 2

New Jersey, New York City and
counties of Nassau, Rockland,
Suffolk, and Westchester

Holtsville, NY 00501

New York (all other counties),
Connecticut, Maine,
Massachusetts, New Hampshire,
Rhode island, Vermont

‘Andover, MA 05501

District of Columbia, Delaware,

Maryland, Fonmenieane Philadelphia, PA 19255

Alabama, Florida, Georgie,

Mississipp1, South Carolina Atlanta, GA 31101

Michigan, Ohio Cincinnati, OH 45999

‘Arkansas, Kansas, Louisiana,

New Mexico, Okiahoma, Texas Austin, TX 73301

Riaska, Arizona, Colorado, Idaho,
Minnesota, Montana, Nebraska,
Nevada, North Dakota, Oregon,
South Dakota, Utah, Washington,
Wyoming

iMinots, lowa, Missouri,
Wisconsin

Ogden, UT 84201

Kansas City, MO 64999
Fresno, CA 93888

California, Hawait

indiana, Kentucky, North
Carolina, Tennessee,
Virgima, West Virginia

Memphis, TN 37501

Ht you have no legal residence, principal place of business or
principal office or agency in any Internal Revenue district, fle your
return with the Internal Revenue Service Center, Philadelphia, PA
19255

Specific Instructions

These instructions explain how to complete Form
720. Line items with no instructions are self-
explanatory.

Name, Address, and Employer Identification
Number.—The first time you file Form 720, enter the
Tequired information. After this, IRS will mail you a
preaddressed return every 3 months. Please use the
preaddressed form.

If you use a non-preaddressed form, type or print
your name, address, and employer identification number
(EIN) exactly as shown on earlier returns. Do not use an
EIN of a former owner of a business. For information on
applying for an EIN, or filing a return if the EIN has not
been received, see Publication 583, Information for
Business Taxpayers—Business Taxes, Identification
Numbers, Recordkeeping.

‘Tax Computation Columns.—Figure the taxes that
apply by using the appropriate figures in the ‘‘rate””
columns. Add the amounts of tax in the “tax”” columns,
and enter the total tax on line 1

Facilities and Services

a, Communications services.—Amounts paid for
communication services do not include State or local
taxes paid if the amount is separately stated in the bill to
the customer.

b. Policies issued by foreign insurers. —Tax rates
are as follows:

(1) Casualty insurance and indemnity bonds.—4¢
on each dollar (or fraction of a dollar) of the premium
paid on the policy or bond

(2) Life surance, sickness and accident policies,
and annuity contracts. —1¢ on each dollar (or fraction
of a dollar) of the premium paid on the policy or
contract.

(3) Reinsurance. —1¢ on each dollar (or fraction of a
dollar) of the premium paid on the policy of reinsurance
covering any of the contracts taxable in (1) or (2) above.

¢. Registration-required obligations not issued in
registered form.—1% of the principal amount of the
obligation multiplied by the number of calendar years (or
portions thereof) during the period beginning on the
issue date and ending on the maturity date.
Manufacturers

These taxes apply to the sale or use by the

manufacturer, producer, or importer of the articles
listed. These taxes may also apply to one part of an
otherwise nontaxable article, such as tires on imported
vehicles.

See Publication 510 for information on tax-free
purchases of tires, tubes, or tread rubber and using
Form 637, Certificate of Registry.

a. Basis for tax and adjustment.—Compute the tax
on the price for which the taxable article is sold or
leased. For a taxable article that is sold or leased under a
conditional sales contract, installment payment
contract, or chattel mortgage arrangement, compute
and pay the tax on each payment received during the
quarter covered by the return. For exclusion from the
sale price of local advertising charges, cost of
transportation, etc.,. see Publication 510. There are also
special rules that apply to the lease of any article.

You may adjust the manufacturers sale price for
discounts, rebates, and similar allowances granted to
the purchaser. You may not anticipate such discounts.
The purchaser must have taken the discount before the
return is required to be filed.

Ifyou make adjustments or get the required evidence
after you file your return, you may be able to take a
credit on a later return or file a refund claim,

You must compute the tax on a price established by
the Commissioner of Internal Revenue if an article 1s.
sold by the manufacturer or producer at retail, on
consignment, or in a way other than through an arm's:
length transaction at less than the fair market price; or if
an article 1s used by the manufacturer or producer in a
manner subject to tax,

b, Coal. —The tax on coal per ton (2,000 Ibs.) may
ot be more than 4% of the price at which a ton of coal is
sold in each category. For more information on this tax,
see Publication 510.

¢. Gasoline.— The tax on gasoline 1s 9¢ a gallon.
But see also “‘Gasohol and other Alcohol Fuels.”

if gasoline 1s used in a qualified taxicab, you may
qualify for a credit or refund of 4¢ a gallon. See Form
4136, Computation of Credit for Federal Tax on
Gasoline, Special Fuels, and Lubricating Oil

4. Alcohol sold as but not used as a fuel.—Alcohol,
either mixed or straight, designated for use as fuel is
eligible for a credit. Form 6478, Credit for Alcohol Used
as Fuel, is used to compute the credit. If the credit is
allowable and any person later either (1) uses a mixture
or straight alcohol for a purpose other than fuel, (2)
‘separates the alcohol from the mixture, or (3) mixes the
straight alcohol, an excise tax is imposed. The tax 1s 50¢
a gallon for each gallon of alcohol that is at least 190
proof and 374¢ a gallon for each gallon of alcohol that
isat least 150 proof but less than 190 proof

e. Floor stock tax on tires. —Dealers who are
holding tires that are available for sale on January 1,
1984, must pay a one-time floor stock tax on those tires,
The tax applies to the total weight of a tire (pounds and
ounces). The tax is as follows:

(a) For tires weighing more than 81 pounds 7 ounces
and less than 82 pounds—.375¢ PLUS 1.276 for each
ounce over 81 pounds 8 ounces.

(b) For tires weighing 82 pounds or more and less
than 90 pounds 1 ounce—10.5¢ PLUS 20.25¢ for each
ound over 82 pounds,

(c) For tires weighing more than 90 pounds—$1.725
PLUS 40.25¢ for each pound over 90 pounds.

The tax must be paid and Form 720 filed marked
“FINAL” by February 16, 1984, if you do not owe any
other excise taxes due on Form 720. If you do owe other
Form 720 taxes, you may file the floor stock tax return
by the last day of April 1984.

f. Tread rubber. a tire, exported from the United
States, is recapped or retreaded (other than bead to.
bead) outside the United States, and then is imported
into the United States, the importer is liable for the
excise tax on tread rubber. See section 407 1(1) for more
information.

Fuel economy.—Compute the tax on Form 6197,
Fuel Economy Tax, and report it quarterly on Form 720.
File Form 6197 annually as an attachment to Form 720.

Retail and Use Taxes

The excise tax on trucks and trailer chassis, and
bodies, and tractors is now a retailers tax. It applies to
vehicles used mainly for highway transportation, which
have a gross vehicle weight over 33,000 pounds. It also
applies to truck trailers and semitrailer chassis and
bodies for use with a trailer or semitrailer with a gross
vehicle weight over 26,000 pounds. All tractors are tax
able. See Publication 510 for the special 2% retailers tax
on these articles for which a 10% manufacturers tax has
already been imposed.

A.9¢ per gallon tax applies to diesel fuel sold for use or
used in a highway motor vehicle and to special motor
fuel sold for or used in a motor vehicle or motorboat
(other than a commercial fishing boat). A 4¢ per gallon
tax applies to the sale of any mixture containing diesel or
special motor fuel and 10% alcohol that is at least 190
proof. Qualified methanol or ethanol fuels and off-
highway business use of fuels are exempt from the tax.
For a refund or credit of the fuel tax when the 9¢ a gallon
rate does not apply, see Form 4136.

(Instructions continued on page 4)


om 120

(Rev. October 1983)

Department of the Treasury—Internal Revenue Service

Quarterly Federal Excise Tax Return

> For Paperwork Reduction Act Notice, see instructions.

OMB No. 1545-0023

Use to Report Excise
Taxes for 1983 and the
Floor Stock Tax on Tires

Type or print in this space your name, address, and employer identification

number as shown on original

Return for calendar quarter ending
(Enter month and year as on original)

YOUR COPY

PART |.—Computation of Tax I

items

PART I1.—Computation of Net Tax Liability

Facilities and Services Rate Tax IRS | 1 Totaltax. Add all amounts from Part! . |_$
Tolltelephoneservice . . . . “1 2 Adjustments. (See instructions. Attach
Teletypewriter exchange service 3% 22 statement.)
Local telephone service . 3. Taxas adjusted $
Transportation of persons by ait 8% 26 | 4 (a) Record of Tax Liability. (See instructions on page 4.)
Use of international artravel facilities. . | $3,00per 27 Perlod Amount of Liabili
Transportation of property by air . 5% 28 | rigge ESE Sth Gey
Policies issued by foreign insurers. . *) 30 | Month | 16th-last day
Obligations not in registered form . (*) 31 Total for month
Manufacturers Second ee SS
Coal (1 ton = 2,000 Ibs.): Month | L6th-last day SSS
a Underground mined @ $1.00 per ton 36 Total or 000) —_—$————
b_ Underground mined @ 4% of ton price *) 37 | hig ESE 1StR Gay
© Surface mined @ 506 per ton 38 | Month | 16th-last day ——|
d Surface mined @ 4% of ton price (o) 39 Total for month —
Fishing rods, and artificial lures, etc. . | 10% 41 (b) Total liability for quarter
Bows and arrows. 11% 44 (c) Total deposits for quarter
Pistols and revolvers. | 10% 32 | 5 Overpayment from previous quarter. >
Firearms other than pistols and revohers) . | 1196 46 Total deposits (item 4(c) plus item 5) >
Shells and cartridges... 11% 49 | 7 Undeposited taxes due (item 3 less item
Gasoline (manufacturers tax) . (*) 62 6; this should be $100 or less). Pay to
Alcohol sold as but not used as fuel (*) 51 Internal Revenue Service. . . . >
highway veicletype 9.75¢ Ib. Note: If undeposited taxes due at the end of the quarter are more
Tires {Iarint eo eas ‘a 66 than $100 the entire balance must be deposited.
Floor stocktires . ¢) 57 If you make semimonthly deposits and claim one of the deposit
exceptions, please indicate the exception:
Inner tubes 10¢ Ib. 67
Tread rubber (camelback) . 5¢ Ib. 68 10 20 30 40
Fuel economy *) |__| 40 Gasoline producers or refiners who are eligible for the 14-day
Retail and Use Taxes depositary due date, please check this box. B C1
Truck and traller chassis and bodies; tractors. | 12% (*) 33 | 8 Ifitem6ismorethanitem 3, enterexcesshere » $ _..--_..
Diesel fuel and special motor fuels. () 61 and check if you want it: [1] applied to your next return, or
Inland waterway fuel 8¢ gal. 64 1 refunded to you.
Fuel used in Fuel other 14¢ gal. (*) 69 | 9 Ifnot liable for returns in succeeding quarters, write “FINAL”
noncommercial} than gasoline
aviation Gasoline (retailers tax) 3¢ gal. (*) 14 a
Crude Oil Windfall Profit Tax and return this form to your Infernal Revenue Service Center.
Quarterly return (Attach Form 6047) (o) 50
Annual return ro 52 | Social security number for IRS No. 52_>
Environmental Taxes
Petroleum (Attach Form 6627) *) 53
Chemicals (Attach Form 6627) (*) |__| 54
Hazardous wastes (attach Form
6627), . . we (*) 55

*See instructions on pages 2 and 4.

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

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