rom 6118 Claim of Income Tax Return Preparers

(Rev. May 1987)

Department of the Treasury > See instructions on back,

Internal Revenue Service.

OMB No. 1545-0240
Expires 4-30-90

| Nameof preparer Your social security number or employer
2 identification number
Ss
5 Address to which statement(s) of notice and demand were mailed
=
E | Cityortown, state, and ZIP code IRS office that sent statement(s)
°
2
& | Address shown on return(s) if different from above
a
1 Kind of Penalty (Enter letter in column 2(c).) Failure to furnish identification number—6695(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)

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Failure to retain copy or list—-6695(d)
Failure to file a record of return preparers—6695(e)(1)

Failure to include an item in the required record of
return preparers—6695(e)(2)
I Negotiation of check—6695(f)

2__ Identification of Penalties (See Specific Instructions.)

Statement document Date of
locator number statement

(a) (b)

Kind of
penalty

(c)

Amount
assessed

(da)

Amount
paid
(e)

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

qd)

(2)

(3)

(4)

(5)

(6)

2)

(8)

(9)

(10)

ap

(12)

(13)

(14)

Taxpayer's name
(g)

Taxpayer's
identification number

(h)

Form
involved

0)

Taxable
year

G)

()

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(0)

4)

d2)

(13)

4)

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. 5-87)


Form 6118 (Rev. 5-87)

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
required to give us this information.

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

Purpose of Form.—File Form 6118 to claim a refund for
the overpayment of preparer penalties. 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 1.—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 Form 5972,
Income Tax Return Without a Preparer’s Signature, or
(dentification Number or Both, or Form 6335, Statement of
Tax Due IRS) and a penalty imposed by an IRS district office
(shown on Form 6335) 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 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
identification number.

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 |) from item 1 to indicate the kind of
penalty on each line.

Fill in columns 2(d) and 2(g) through 2(j) using the
information 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
statement(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
penalty by line number and write your explanation next to it.

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