Amount of refund

Use the space below for an explanation of each claim listed.

Other Claims OMB No. 1545-1420

(Rev. January 2001)

Schedule 6 Department of the Treasury—Internal Revenue Service

(Form 8849)

 Attach to Form 8849.

For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions. Cat. No. 27454M Schedule 6 (Form 8849) (Rev. 1-2001)

Name as shown on Form 8849 Total refund

 See instructions on page 2.

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6

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8

9

Claim

Enter the earliest and latest dates of the events included in this claim. Enter in MMDDYYYY format.

Earliest date  Latest date 

Claimant’s registration number for Section 4091(d) claims. 

$

EIN or SSN

$
Schedule 6 (Form 8849) (Rev. 1-2001) Page 2

Instructions

Section references are to the Internal Revenue Code.

Claim Requirements

Claims require the following information:

1. A statement why the refund is allowable.

2. A statement that the claimant has any required

supporting evidence.

Purpose of Schedule

3. The dollar amount of the claim.

4. The form number of the tax return to which the claim

relates.

5. Any additional information as required by regulations.

Section 4091(d) Claims

Caution: This claim cannot be filed with any other claim. See

Schedules Attached on Form 8849.

If a registered aviation fuel producer bought aviation fuel

on which tax was paid to the government, then a claim for

refund of the tax may be made.

Claimant

Claim Requirement

1. Volume and type of aviation fuel.

2. Date on which the second producer acquired the

aviation fuel included in the claim.

3. Amount of tax that the first producer paid to the

government.

5. The name, address, and EIN of the person who paid the

prior tax to the government.

6. A copy of the First Producer’s Report that relates to the

aviation fuel covered by the claim.

7. A copy of any Statement of Subsequent Seller that the

second producer received with respect to that aviation fuel.

How To File

Form 2290, Heavy Highway Vehicle Use Tax

Return

A claim for refund may be made for the following:

1. A pro rata refund of the tax paid on Form 2290 for a

vehicle that was destroyed or stolen before June 1 of any

period (July 1–June 30) and subsequently not used during

the period. To make a claim for a vehicle that is destroyed or

stolen, the following information must be attached to

Schedule 6:

a. The vehicle identification number (VIN),

b. Whether the vehicle was destroyed or stolen,

c. Date of the accident or theft, and

d. Computation of the refund amount. See the line 4

instructions for Form 2290.

2. Any vehicle on which the tax was paid on Form 2290 if

the vehicle was used 5,000 miles or less on public highways

(7,500 or less for agricultural vehicles) during the period (July

1–June 30). The mileage limitation applies to the total

mileage a vehicle is driven during a period regardless of the

number of owners of the vehicle. A claim for this mileage

refund cannot be filed until after June 30 of the period.

Form 730, Monthly Tax on Wagering

4. If the fuel was sold, a statement certifying that the

amount of the prior tax has not been included in the price of

the fuel and has not been collected from the purchaser by

the claimant.

How To File

How To File

Schedule 6 (Form 8849) (Rev. 1-2001)

The registered producer that bought taxed aviation fuel is the

only person eligible to make this claim.

Attach all of the following information to Schedule 6:

Generally, a claim must be filed within 3 years of the filing of

the return to which the claim relates, or 2 years from when

the tax reported on that return was paid, whichever is later.

Attach Schedule 6 to Form 8849. Write “Section 4091(d)” at

the top of Form 8849 and on the envelope and mail to the

address under Where To File in the Form 8849 instructions.

Attach Schedule 6 to Form 8849. Mail to the IRS at the

address under Where To File in the Form 8849 instructions.

Attach Schedule 6 to Form 8849. Mail to the IRS at the

address under Where To File in the Form 8849 instructions.

Use Schedule 6 for other claims, including refunds of excise

taxes reported on:

● Form 720, Quarterly Federal Excise Tax Return, including

section 4091(d) claims;

● Form 730, Monthly Tax on Wagering;

● Form 11-C, Occupational Tax and Registration Return for

Wagering; or

● Form 2290, Heavy Highway Vehicle Use Tax Return.

Total Refund

Add the amounts on lines 1 through 9 and enter the result in

the total refund box at the top of the schedule.

A claim for refund may be made for the following:

1. An overpayment of tax. The following information must

be attached to the claim.

● The facts involving the overpayment.

● The reason for claiming a refund.

● The date of payment and the amount of the tax.

● Whether any previous claim covering the amount involved,

or any part, has been filed.

● A statement that you:

a. Have not collected (whether as a separate charge or

otherwise) the amount of the tax from the person that placed

the wager on which the tax was imposed, or

b. Have repaid the amount of the tax to the person that

placed the wager, or

c. Have the written consent of the person that placed the

wager to the making of the refund (the consent must be

attached to the claim).

● If the overpayment relates to a laid-off wager accepted by

you, one of the above three statements must be attached for

both the person that placed the laid-off wager and the

person that placed the original wager.

2. Credit for wagers laid off by you. The following

information must be attached to the claim.

● The certificate described in Regulations section

44.6419-2(d).

● A statement that includes:

a. The reason for the refund,

b. The month in which the tax was paid,

c. The date of payment, and

d. Whether any previous claim covering the amount

involved, or any part, has been filed.