burden

Version A, Cycle 3

delete see B
Form 720 (Rev. 7-2010)
IRS No.

Page

Manufacturers Taxes

36
37
38
39

Number of tons

Sales price

Rate

Tax

$1.10 per ton
4.4% of sales price
$ .55 per ton

Coal—Underground mined
Coal—Surface mined

36
37
38
39

4.4% of sales price
Tax

Number of tires

Taxable tires other than bias ply or super single tires
Taxable bias ply 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)

108
109
113
40
97

Foreign Insurance Taxes— Policies issued by foreign insurers
Casualty insurance and indemnity bonds

30
1

IRS No.

108
109
113
40
97

. . . .

Premiums paid

Rate

$ .04
.01
.01

Life insurance, sickness and accident policies, and annuity contracts
Reinsurance
Total. Add all amounts in Part I. Complete Schedule A unless one-time filing

2

IRS No.

Tax

}
a

IRS No.

30
$

Part II
IRS No.

41
110
42
114
44
106
140

DRAFT AS OF
D
July 29, 2010
Number of gallons

Part III

6
7
8
9
10
11

Tax

Rate

a

Do you want to allow another person to discuss this return with the IRS (see instructions)?

64
125
51
117
20
$

a

3

a

9
10

a

11
Yes. Complete the following.

Phone
no. a

Designee
g
name a

41
110
42
114
44
106
140

$ .20
.001

Total tax. Add Part I, line 1, and Part II, line 2 . . . . . . . . . . . . . . . . .
Claims (see instructions; complete Schedule C) . . . . . . . a
4
Deposits made for the quarter . . . . a
5
Check here if you used the safe harbor rule to make your deposits.
Overpayment from previous quarters . . a
6
Enter the amount from Form 720X included
on line 6, if any . . . . . . . . . a
7
deleted C
Add lines 5 and 6 . . . . . . . . . . . . . . . . . a
8
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.

Third
Party
Designee

IRS No.

10% of sales price
10% of sales price
3% of sales price
3% of sales price
11% of sales price
$ .45 per shaft
10% of amount paid

64 Inland waterways fuel use tax
125 LUST tax on inland waterways fuel use (see instructions)
51 Alcohol and cellulosic biofuel sold as but not used as fuel
117 Biodiesel sold as but not used as fuel
20 Floor Stocks Tax— Ozone-depleting chemicals (floor stocks). Attach Form 6627.
2
Total. Add all amounts in Part II
3
4
5

Tax

Rate

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
Indoor tanning services

No

Personal identification
number (PIN) a

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.

Signature

Deletion D

Type or print name below signature.
F

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

deleted line and "Total" and moved "Floor Stocks Tax"
delete see A

Title

Telephone number
Date

F

Paid
Preparer’s
Use Only

Preparer’s
signature

Date

F

F

Sign
Here

Check if
selfemployed

Preparer’s SSN or PTIN

EIN
Phone no.
Form 720 (Rev. 7-2010)