Free Form 720 (Rev. January 2009) - Federal

Form

720
Name

Quarterly Federal Excise Tax Return
OMB No. 1545-0023

(Rev. January 2009) Department of the Treasury Internal Revenue Service

See the Instructions for Form 720.

Check here if: Final return Address change

Quarter ending

FOR IRS USE ONLY
T FF FD FP I T

Number, street, and room or suite no. (If you have a P.O. box, see the instructions.)

Employer identification number

City, state, and ZIP code. (If you have a foreign address, see the instructions.)

Part I
IRS No.

18 21 98 19 22 26 28 27

60

Environmental Taxes (attach Form 6627) Domestic petroleum oil spill tax Imported petroleum products oil spill tax Ozone-depleting chemicals (ODCs) ODC tax on imported products Communications and Air Transportation Taxes (see instructions) Local telephone service and teletypewriter exchange service Transportation of persons by air Transportation of property by air Use of international air travel facilities Number of gallons Fuel Taxes (a) Diesel fuel, tax on removal at terminal rack (b) Diesel fuel, tax on taxable events other than removal at terminal rack (c) Diesel fuel, tax on sale or removal of biodiesel mixture other than removal at terminal rack Diesel-water fuel emulsion Dyed diesel fuel, LUST tax Dyed kerosene, LUST tax LUST tax, other exempt removals (see instructions) (a) Kerosene, tax on removal at terminal rack (see instructions) (b) Kerosene, tax on taxable events other than removal at terminal rack Kerosene for use in aviation (see instructions) Kerosene for use in commercial aviation (other than foreign trade)
Kerosene for use in aviation, LUST tax on nontaxable uses

Tax

IRS No.

18 21 98 19
Tax

22 26 28 27
Rate Tax

$.244 .244 .244 .198 .001 .001 .001 .244 .244 .219 .044 .001 .184 .184 .184 .194 .183 .184 .183 .184 .244 .244 .243
Rate Tax

60

104 105 107 119 35 69 77 111 79

104 105 107 119 35 69 77 111 79 62

Other fuels (see instructions) (a) Gasoline, tax on removal at terminal rack (b) Gasoline, tax on taxable events other than removal at terminal rack (c) Gasoline, tax on sale or removal of alcohol fuel mixture other than removal at terminal rack Aviation gasoline Liquefied petroleum gas (LPG) "P Series" fuels Compressed natural gas (CNG) (GGE = 126.67 cu. ft.) Liquefied hydrogen Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process Liquid fuel derived from biomass Liquefied natural gas (LNG) Retail Tax Truck, trailer, and semitrailer chassis and bodies, and tractors Ship Passenger Tax Transportation by water Other Excise Tax Obligations not in registered form

62 14 112 118 120 121 122 123 124 33 29 31

14 112 118 120 121 122 123 124 33
Tax

12% of sales price
Number of persons Rate

$3 per person
Amount of obligations

29
Tax

Rate

$ .01
Cat. No. 10175Y Form

31

For Privacy Act and Paperwork Reduction Act Notice, see the instructions.

720

(Rev. 1-2009)

Form 720 (Rev. 1-2009) IRS No.

Page Number of tons Sales price Rate Tax

2

Manufacturers Taxes Coal--Underground mined Coal--Surface mined

IRS No.

36 37 38 39 108 109 113 40 97

$1.10 per ton
4.4% of sales price

$ .55 per ton
4.4% of sales price
Number of tires Tax

36 37 38 39
IRS No.

Taxable tires other than biasply or super single tires Taxable biasply or super single tires (other than super single tires designed for steering) Taxable tires, super single tires designed for steering Gas guzzler tax. Attach Form 6197. Check if one-time filing. Vaccines (see instructions) Foreign Insurance Taxes--Policies issued by foreign insurers Premiums paid Casualty insurance and indemnity bonds Life insurance, sickness and accident policies, and annuity contracts 30 Reinsurance 1 Total. Add all amounts in Part I. Complete Schedule A unless one-time filing

108 109 113 40 97
Rate Tax IRS No.

$ .04 .01 .01 $
Rate Tax

30

Part II
IRS No. IRS No.

41 110 42 114 44 106 64 125 51 117

Sport fishing equipment (other than fishing rods and fishing poles) Fishing rods and fishing poles (limits apply, see instructions) Electric outboard motors Fishing tackle boxes Bows, quivers, broadheads, and points Arrow shafts
Number of gallons

10% of sales price 10% of sales price 3% of sales price 3% of sales price 11% of sales price $ .45 per shaft
Rate Tax

41 110 42 114 44 106 64 125 51 117
Tax

Inland waterways fuel use tax LUST tax on inland waterways fuel use (see instructions) Alcohol and cellulosic biofuel sold as but not used as fuel Biodiesel sold as but not used as fuel Floor Stocks Tax 20 Ozone-depleting chemicals (floor stocks). Attach Form 6627. 2 Total. Add all amounts in Part II

$ .20 .001

20 $ 3 4

Part III
3 4 5 Total tax. Add line 1, Part I, and line 2, Part II Claims (see instructions; complete Schedule C) 5 Deposits made for the quarter Check here if you used the safe harbor rule to make your deposits. 6 Overpayment from previous quarters

6 7 8 9 10 11

Enter the amount from Form 720X 7 included on line 6, if any 8 Total of lines 5 and 6 Add lines 4 and 8 Balance Due. If line 3 is greater than line 9, enter the difference. Pay the full amount with the return(see instructions) Overpayment. If line 9 is greater than line 3, enter the difference. Check if you want the overpayment: Applied to your next return, or Refunded to you.
Do you want to allow another person to discuss this return with the IRS (see the instructions)? Designee name Phone no. ( )

9 10 11
Yes. Complete the following. No

Third Party Designee

Personal identification number (PIN)

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign Here

Signature

Date

Title

Type or print name below signature.

Telephone number ( Date

Paid Preparer's Use Only

Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code

) Check if selfemployed EIN

Preparer's SSN or PTIN

Phone no. ( Form

)

720

(Rev. 1-2009)

Form 720 (Rev. 1-2009)

Page

3

Schedule A

Excise Tax Liability (see instructions)

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 Part II taxes or for a one-time filing of the gas guzzler tax.
1 Regular method taxes (a) Record of Net Tax Liability First month A Second month C Third month E Special rule for September*

Period 1st­15th day B D F G 16th­last day

(b) Net liability for regular method taxes. Add the amounts for each semimonthly period. 2 Alternative method taxes (IRS Nos. 22, 26, 28, and 27) (a) Record of Taxes Considered as Collected M First month O Second month Q Third month Special rule for September* Period 1st­15th day N P R S 16th­last day

(b) Alternative method taxes. Add the amounts for each semimonthly period.
*Complete only as instructed. See the instructions.

Schedule T

Two-Party Exchange Information Reporting (see instructions)
Number of gallons

Fuel Diesel fuel, gallons received in a two-party exchange within a terminal, included on IRS No. 60(a) on Form 720 Diesel fuel, gallons delivered in a two-party exchange within a terminal Kerosene, gallons received in a two-party exchange within a terminal, included on IRS No. 35(a), 69, 77, or 111 on Form 720 Kerosene, gallons delivered in a two-party exchange within a terminal Gasoline, gallons received in a two-party exchange within a terminal, included on IRS No. 62(a) on Form 720 Gasoline, gallons delivered in a two-party exchange within a terminal Aviation gasoline, gallons received in a two-party exchange within a terminal, included on IRS No. 14 on Form 720 Aviation gasoline, gallons delivered in a two-party exchange within a terminal

Form

720

(Rev. 1-2009)

Form 720 (Rev. 1-2009)

Page

4

Schedule C Month your income tax year ends Claims Complete Schedule C for claims only if you are reporting liability in Part I or II of Form 720.
Attach a statement explaining each claim as required. Include your name and EIN on the statement. See the instructions. Caution. Claimant has the name and address of the person(s) who sold the fuel to the claimant, the dates of purchase, and if exported, the required proof of export. For claims on lines 1a and 2b (type of use 13 and 14), 3c, 4b, and 5, claimant has not waived the right to make the claim. 1 Nontaxable Use of Gasoline Period of claim
Type of use Rate $.183 .184 Gallons $ Amount of claim CRN 362 411

a Gasoline (see Caution above line 1) b Exported (see Caution above line 1) 2 Nontaxable Use of Aviation Gasoline
Type of use

Period of claim
Rate
$.15

Gallons $

Amount of claim

CRN 354 324 412 433

a b c d 3

Used in commercial aviation (other than foreign trade) Other nontaxable use (see Caution above line 1) Exported (see Caution above line 1) LUST tax on aviation fuels used in foreign trade

.193 .194 .001

Nontaxable Use of Undyed Diesel Fuel Period of claim Claimant certifies that the diesel fuel did not contain visible evidence of dye. Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here
Type of use Nontaxable use Use in trains Use in certain intercity and local buses (see Caution above line 1) Use on a farm for farming purposes Exported (see Caution above line 1) Rate $.243 .243 .17 .243 .244 Gallons $ Amount of claim CRN 360 353 350 360 413

a b c d e 4

Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation) Period of claim Claimant certifies that the kerosene did not contain visible evidence of dye. Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check here
Caution. Claims cannot be made on line 4 for kerosene sales from a blocked pump. Type of use Nontaxable use Use in certain intercity and local buses (see Caution above line 1) Use on a farm for farming purposes Exported (see Caution above line 1) Nontaxable use taxed at $.044 Nontaxable use taxed at $.219 Rate $.243 .17 .243 .244 .043 .218 Gallons $ Amount of claim CRN 346 347 346 414 377 369

a b c d e f 5

Kerosene Used in Aviation (see Caution above line 1)
Type of use Rate $.200
.175

Period of claim
Gallons $ Amount of claim CRN 417 355 346 369 433
Form

a Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244

b Kerosene used in commercial aviation (other than foreign trade)
taxed at $.219

c Nontaxable use (other than use by state or local government)
taxed at $.244 .243
.218

d Nontaxable use (other than use by state or local government)
taxed at $.219

e LUST tax on aviation fuels used in foreign trade

.001

720

(Rev. 1-2009)

Form 720 (Rev. 1-2009)

Page

5

6

Nontaxable Use of Alternative Fuel Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See the Instructions for Form 720 for the credit rate.
Type of use Rate $.183 .183 .183 .183 .243 .243 .243 .183
Gallons or gasoline gallon equivalents (GGE)

Amount of claim $

CRN 419 420 421 422 423 424 425 435

a b c d e

Liquefied petroleum gas (LPG) "P Series" fuels Compressed natural gas (CNG) (GGE = 126.67 cu. ft.) Liquefied hydrogen Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process

f Liquid fuel derived from biomass g Liquefied natural gas (LNG) h Liquefied gas derived from biomass 7 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Period of claim Registration Number Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye. Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here
Rate Gallons $ Amount of claim CRN 360 350

a Use by a state or local government b Use in certain intercity and local buses 8 Sales by Registered Ultimate Vendors of Undyed Kerosene (Other Than Kerosene For Use in Aviation)

$.243 .17

Period of claim Registration Number Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye. Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check here
Rate Gallons $ Amount of claim CRN 346 347

a Use by a state or local government b Sales from a blocked pump c Use in certain intercity and local buses 9 Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

$.243 .243 .17

Registration Number

Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to make the claim. See the instructions for additional information to be submitted.
Type of use Rate $.175 .200 .025 .243 .218 .001 Gallons $ Amount of claim CRN 355 417 418 346 369 433

a b c d e f 10

Use in commercial aviation (other than foreign trade) taxed at $.219 Use in commercial aviation (other than foreign trade) taxed at $.244 Nonexempt use in noncommercial aviation Other nontaxable uses taxed at $.244 Other nontaxable uses taxed at $.219 LUST tax on aviation fuels used in foreign trade

Sales by Registered Ultimate Vendors of Gasoline

Registration Number

Claimant sold the gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired certificate from the buyer and has no reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.
Rate Gallons $
Form

Amount of claim

CRN 362

a Use by a nonprofit educational organization b Use by a state or local government

$.183 .183

720

(Rev. 1-2009)

Form 720 (Rev. 1-2009)

Page

6

11

Sales by Registered Ultimate Vendors of Aviation Gasoline

Registration Number

Claimant sold the aviation gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to take the claim; and obtained an unexpired certificate from the buyer and has no reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.

a Use by a nonprofit educational organization b Use by a state or local government 12 Alcohol Fuel Mixture Credit

Rate $.193 .193

Gallons $

Amount of claim

CRN 324

Period of Claim Registration Number

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. See Line 12. Alcohol Fuel Mixture Credit in the Instructions for Form 720. Rate Gal. of Alcohol $ Amount of claim CRN 393 394

a Alcohol fuel mixtures containing ethanol b Alcohol fuel mixtures containing alcohol (other than ethanol) 13 Biodiesel or Renewable Diesel Mixture Credit

$.45 .60

Period of Claim Registration Number

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM D6751 and met EPA's registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing renewable diesel with liquid fuel (other than renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass, met EPA's registration requirements for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller, both of which have been edited as discussed in the instructions for line 13. See the instructions for line 13 for information about renewable diesel used in aviation. Gal. of Biodiesel or Rate Renewable Diesel Amount of claim CRN

a b c 14

Biodiesel (other than agri-biodiesel) mixtures Agri-biodiesel mixtures Renewable diesel mixtures

$1.00 1.00 1.00

$

388 390 307

Alternative Fuel Credit and Alternative Fuel Mixture Credit

Registration Number

For the alternative fuel mixture credit, claimant produced a mixture by mixing taxable fuel with alternative fuel. Claimant certifies that it (a) produced the alternative fuel, or (b) has in its possession the name, address, and EIN of the person(s) that sold the alternative fuel to the claimant; the date of purchase; and an invoice or other documentation identifying the amount of the alternative fuel. The claimant also certifies that it made no other claim for the amount of the alternative fuel, or has repaid the amount to the government. The alternative fuel mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Gallons or Rate Amount of claim CRN gasoline gallon equivalents (GGE) (see instructions) a Liquefied petroleum gas (LPG) $ $.50 426 .50 b "P Series" fuels 427

c d e f g h i 15 a b c d e f g h i j k 16

Compressed natural gas (CNG) (GGE = 121 cu. ft.) Liquefied hydrogen Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process Liquid fuel derived from biomass Liquefied natural gas (LNG) Liquefied gas derived from biomass Compressed gas derived from biomass (GGE = 121 cu. ft.)

.50 .50 .50 .50 .50 .50 .50 Amount of claim

428 429 430 431 432 436 437 CRN 366 415 416

Other claims. See the instructions. For lines 15b and 15c, see the Caution above line 1 on page 4.
Section 4051(d) tire credit (tax on vehicle reported on IRS No. 33) Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001 Exported dyed kerosene Diesel-water fuel emulsion Registered credit card issuers Number of tires Taxable tires other than biasply or super single tires Taxable tires, biasply or super single tires (other than super single tires designed for steering) Taxable tires, super single tires designed for steering $ Amount of claim CRN 396 304 305 $

Total claims. Add all amounts on lines 1­15. Enter the result here and on page 2, Part III, line 4 of Form 720.

16
Form

720

(Rev. 1-2009)

Form 720-V, Payment Voucher
Purpose of Form
Complete Form 720-V if you are making a payment by check or money order with Form 720, Quarterly Federal Excise Tax Return. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. If you have your return prepared by a third party and a payment is required, provide this payment voucher to the return preparer. Do not file Form 720-V if you are paying the balance due on line 10 of Form 720 using EFTPS. Box 2. Enter the amount paid from line 10 of Form 720. Box 3. Darken the capsule identifying the quarter for which the payment is made. Darken only one capsule. Box 4. Enter your name and address as shown on Form 720. Enclose your check or money order made payable to the "United States Treasury." Be sure to enter your EIN (SSN for one-time filing), "Form 720," and the tax period on your check or money order. Do not send cash. Do not staple this voucher or your payment to the return (or to each other). Detach the completed voucher and send it with your payment and Form 720. See Where To File on page 2 of the Instructions for Form 720.

Specific Instructions
Box 1. If you do not have an EIN, you may apply for one online. Go to the IRS website at www.irs.gov/businesses/small and click on the "Employer ID Numbers (EIN)" link. You may also apply for an EIN by calling 1-800-829-4933, or you can fax or mail Form SS-4, Application for Employer Identification Number, to the IRS. However, if you are making a one-time filing, enter your social security number.

Detach Here and Mail With Your Payment and Form 720.

Form

720-V

(2009)

720-V
Department of the Treasury Internal Revenue Service (77)

Payment Voucher
Do not staple or attach this voucher to your payment.
2

OMB No. 1545-0023

2009
Dollars Cents

1 Enter your employer identification number.

Enter the amount of your payment.
4 Enter your business name (individual name if sole proprietor).

3 Tax period

1st Quarter 2nd Quarter

3rd Quarter 4th Quarter

Enter your address.

Enter your city, state, and ZIP code.