Form 720 Quarterly Federal Excise Tax Return

(Rev. January 1999) OMB No. 1545-0023

Department of the Treasury

Internal Revenue Service

© For Privacy Act and Paperwork Reduction Act Notice,

see the separate instructions.

If you are not using

a preprinted label,

enter your name,

address, employer

identification

number, and

calendar quarter of

return. See the

separate

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 page 2.)

FD

FP

City, state, and ZIP code (If you have a foreign address, see page 2.) I

T

Check here if this is a final return ©

Environmental Taxes (Attach Form 6627.) Tax IRS No.

Ozone-depleting chemicals (ODCs) 98

Communications and Air Transportation Taxes Tax IRS No.

Local telephone service, toll 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 IRS No.

60

Dyed diesel fuel used in trains 71

.184

Liquefied petroleum gas (LPG) (such as propane or

butane)

79

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

at terminal rack

.14444 58

Gasoline removed or entered for gasohol production

containing at least 10% alcohol

.15430 73

Aviation fuel (other than gasoline) .219 69

Aviation gasoline 14

.044 77

Aviation fuel (other than gasoline) for use in commercial

aviation (other than foreign trade)

Form 720 (Rev. 1-99)

98

22

26

28

27

60

71

61

62

58

73

69

14

77

IRS No.

IRS No.

IRS No.

78 Dyed diesel fuel used in certain intercity or local buses .074

79 Other fuels (See instructions.)

61

78

.136

Cat. No. 10175Y

©

Part I

19 ODC tax on imported products 19

(a) Gasoline, tax on removal at terminal rack

.184

59 Gasohol containing at least 10% alcohol .130 59

Gasoline removed or entered for gasohol production

containing at least 7.7% alcohol but less than 10% alcohol

.16248 74

74 Gasoline removed or entered for gasohol production

containing at least 5.7% alcohol but less than 7.7% alcohol

.14242 75

Gasohol containing at least 7.7% alcohol but less than

10% alcohol

75

.15322 76

Gasohol containing at least 5.7% alcohol but less than

7.7% alcohol

76

101 Compressed natural gas (taxed at $.4854 per thousand cubic feet) 101

(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 failure to blend or later separation (See instructions.)

or a one-time filing © (See instructions.)

.194

35 35

(a) Kerosene, tax on removal at terminal rack

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

at terminal rack

.244

.244 %

%

%

.044
Form 720 (Rev. 1-99) Page 2

Manufacturers Taxes Number of tons Tax Sales price Rate IRS No.

Coal—Underground mined $1.10 per ton 36

4.4% of sales price 37

Coal—Surface mined $ .55 per ton 38

39

Highway-type tires (See instructions.)

Gas guzzler tax (Attach Form 6197.)

Vaccines (See instructions.) 97

Premiums paid Rate Tax IRS No. Foreign Insurance Taxes

Policies issued by foreign insurers (See instructions.)

Casualty insurance and indemnity bonds $ .04

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

Reinsurance

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

1

2

Adjustments and claims (See instructions. Complete Schedule C.)

Net tax after adjustments and claims. Combine lines 3 and 4. (If no entry on line 4, enter amount

from line 3.)

3

4

5

6

7

8

IRS No.

66

40

36

37

38

39

IRS No.

97

30

66

40

IRS No. Floor Stocks Taxes Tax IRS No.

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

IRS No.

41 Sport fishing equipment

Electric outboard motors and sonar devices

Bows

Inland waterways fuel use tax

Total. Add all amounts in Part II. ©

9

10

Deposits you made for the quarter ©

Total of lines 6 and 7 ©

Balance Due. If line 5 is greater than line 8, enter the difference. This amount must be paid with

the return. Enclose check or money order for full amount payable to the “United States Treasury.”

Write your EIN, “Form 720,” and the quarter on it ©

Overpayment. If line 8 is greater than line 5, enter the difference. If you have an entry that is

less than zero on line 5, combine line 5 and line 8. Check if you want the overpayment:

Applied to your next return, or Refunded to you.

Tax IRS No.

42

44

64

41

42

44

64

IRS No. Number of gallons Rate Tax IRS No.

Overpayment from previous quarter ©

4.4% of sales price

.01

.01

$ .244

$

$

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

51 Alcohol sold as but not used as fuel (See instructions.) .54/.40 51

%

Part III

Part II

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.

Sign

Here © Signature Date © Title

(Please type or print name below signature.) Telephone number ( )

3

4

5

6

7

8

9

10

IRS No. Luxury Tax

92 Passenger vehicles (See instructions.) 92

Tax IRS No.

IRS No. Retail Tax

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

Tax IRS No.

Ship Passenger Tax Number of persons Rate Tax IRS No.

29 Transportation by water $3 per person 29

33

IRS No.

Amount of obligations Rate Tax IRS No.

31 Obligations not in registered form 31

IRS No.

$ .01

Other Excise Tax

Rate

12% of sales price

Rate

6% of sales price over base amount

Rate

10% of sales price

3% of sales price

11% of sales price

102 Arrow components 12.4% of sales price 102
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 taxes on bows, arrow components, electric outboard motors and sonar devices, sport fishing equipment,

alcohol sold as but not used as fuel, inland waterways fuel use, or for any floor stocks taxes or for one-time filings.

1 9-day-rule 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 9-day-rule taxes. (Add the amounts for each semimonthly period.)

2 30-day-rule taxes (IRS Nos. 98 and 19)

G

I

K

Period

1st–15th day 16th–last day

H

J

L

(b) Net liability for 30-day-rule taxes. (Add the amounts for each semimonthly period.)

3 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.)

4 14-day-rule gasoline, diesel fuel, and kerosene taxes (IRS Nos. 60, 35, 62, 58, 73, 74, 59, 75, 76, and 14)

First month S

Second month U

Third month W

Period

1st–15th day 16th–last day

T

V

X

(b) Net liability for 14-day-rule gasoline, diesel fuel, and kerosene taxes. (Add the

amounts for each semimonthly period.)

Record of Net

Tax Liability

(a) Record of Net

Tax Liability

(a) Record of Taxes

Considered as

Collected

First month

Second month

Third month

First month

Second month

Third month

(a) Record of Net

Tax Liability

Form 720 (Rev. 1-99) Page 3

Schedule A Excise Tax Liability (See page 7 of the instructions.)

*Complete only as instructed. See page 8.

Special rule for September* ©

Special rule for September* ©

Special rule for September* ©

Special rule for September* ©
Part I Adjustments to Previously Filed Forms 720

(a)

Quarter

ending

(b)

IRS No.

(d)

Tax as originally reported

on Form 720 or as

previously corrected

(e)

Adjusted tax

(f)

Change

(decrease) or increase

(c)

Type of tax

1 Total adjustments. Combine all amounts in column (f) 1

Part II Claims

Form 720 (Rev. 1-99) Page 4

Schedule C Adjustments and Claims

2

4

75

Gasohol containing at least 10% alcohol

Gasohol containing at least 7.7% alcohol but less than 10% alcohol

Gasohol containing at least 5.7% alcohol but less than 7.7% alcohol

$.130

.14242

.15322

Nontaxable Use of Gasoline and Gasohol

Rate Gallons Amount of claim

Off-highway business use of gasoline $.184 62

Nontaxable Use of Undyed Diesel Fuel and Undyed Kerosene

Rate Gallons

$.244

5

b 60

a

c

Heating oil

Off-highway business use .244

IRS No.

IRS No.

59

76

Amount of claim

Period of claim ©

Month your income tax year ends ©

Period of claim ©

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

Claimant has in its possession the name and address of the person(s) who sold the fuel to the claimant and the date(s) of the purchase(s).

Qualified local and school buses .244

Off-highway business use of:

Caution: Claims cannot be made on line 4 for the tax paid on diesel fuel or

kerosene used on a farm for farming purposes, for the exclusive use of a state

or local government or for sales from a blocked pump.

● Complete Schedule C for adjustments and claims only if you are reporting a liability in Part I or II of

Form 720.

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

See page 8 of the instructions.

a

b

c

d

3 Nontaxable Use of Aviation Gasoline

Nontaxable Use of Aviation Fuel (other than gasoline)

Used in foreign trade or in certain aircraft

Used in commercial aviation (other than foreign trade)

Used in commercial aviation (other than foreign trade)

$.194 14

b

a

b .15

a Used in foreign trade, on a farm, or in certain aircraft

69

Rate Gallons Amount of claim IRS No.

Rate Gallons Amount of claim IRS No.

$.219

Period of claim ©

Period of claim ©

.175

d Certain intercity and local buses .17

6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Rate Gallons

$.244 60 b

a Use on a farm for farming purposes

Use by a state or local government .244

Amount of claim IRS No.

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 sold the fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to take

the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the certificate is false.

UV Registration Number ©

e Train use .20

Exception. If any of the fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here ©

Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Form 720 (Rev. 1-99) Page 5

Part III Total Adjustments and Claims

Total adjustments and claims. Combine the amounts on lines 1 and 12. Enter the

result here and on page 2, Part III, line 4 of Form 720. 13

12

Ozone-depleting chemicals; exported 98

Communications tax; exempt use by the customer 22

Transportation of persons by air; refunds to customer (other than alternative method) 26

Truck, trailer, and semitrailer chassis and bodies; used for further manufacture 33

33

Tires; used in further manufacture of a taxable article 66

Tires; exported, sold or used in foreign trade, or sold to a state or local government or to a 66

nonprofit educational organization

Taxed tires; sold on or in connection with truck, trailer, and semitrailer chassis and bodies, 66

and tractors, reported on IRS No. 33 (See page 4 of the instructions.)

Tax Amount of claim IRS No.

Truck, trailer, and semitrailer chassis and bodies, and tractors; exported

13

Total claims. Add all amounts in Part II of Schedule C. 12

Gasohol Blending

Percentage of alcohol in the gasohol Rate Gallons of

At least 10% alcohol

At least 7.7% alcohol but less than 10% alcohol

At least 5.7% alcohol but less than 7.7% alcohol

8

62

Other claims. See page 10 of the instructions.

9

b

a

c

7

11

Amount of claim IRS No.

(rate x gals. of gasoline)

$.03956

.0297

.02152

Claimant bought gasoline taxed at the full rate and blended it with alcohol to make gasohol. The gasohol was used or sold for use in a

trade or business. For each batch of gasohol, claimant has the required information relating to the purchase of the gasoline and alcohol

used to make the gasohol and to support the amount claimed.

Period of claim ©

Gas guzzler vehicles; resold for emergency use 40

Sales by Registered Ultimate Vendors of Undyed Kerosene

Rate Gallons

b 35

a Use on a farm for farming purposes

Use by a state or local government

Amount of claim IRS No.

Period of claim ©

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

Claimant sold the fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to take

the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the certificate is false.

UV Registration Number ©

c Sale from a blocked pump

Nontaxable Use of LPG in Certain Buses Period of claim ©

Rate Gallons

61 b

a Certain intercity and local buses

Qualified local and school buses

Amount of claim IRS No.

Gasoline Alcohol

Gasoline (Sold for the uses described.)

Gasoline or gasohol was sold to a state or local government for its exclusive

use, to a nonprofit educational organization for its exclusive use, as supplies

for vessels or aircraft, for export, or for use in the production of special fuels.

Claimant obtained a certificate of ultimate purchaser or proof of export from

the buyer or a certificate of ultimate vendor.

Rate Gallons Amount of claim IRS No.

62

75

Gasoline

Gasohol containing at least 10% alcohol

Gasohol containing at least 7.7% alcohol but less than 10% alcohol

Aviation gasoline

$.184

.130

.14242

.194

a

b

c

e

59

14

10 Period of claim ©

d Gasohol containing at least 5.7% alcohol but less than 7.7% alcohol .15322 76

$.244

$.062

.244

.244

.136

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

a

b

c

e

d

f

g

i

h

UP Registration Number ©
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