Form 928 Fuel Bond

Form

928

Fuel Bond

(Rev. OCT 2014)
Department of the Treasury
Internal Revenue Service

(For use to post bond under section 4101)

Check the boxes that apply. This is an
This bond is for:

Part I

OMB No. 1545-0725
Expires MM/DD/YYYY

gasoline,

original bond

diesel fuel, or

strengthening bond

superseding bond

kerosene fuel excise tax.

Enter the effective date
of bond issued
Bond Number

Bonding
Telephone No.

(

Bond is given by

)

Name

Address

as principal and
Name

Address

as surety. As principal and surety, we are obligated to the United States in the amount of
dollars ($
). We also jointly and severally obligate our heirs, executors, administrators, successors, and assigns
for the payment of this amount.
The bond ensures payment of the tax imposed on taxable fuel under section 4081 of the Internal Revenue Code. The
conditions of the bond are that the principal and the surety agree that:
1. The principal will not attempt to defraud the United States of any tax under section 4081;
2. The principal will file all returns and statements as required by law or regulations;
3. The principal will pay all taxes including any penalty and interest charges; and
4. The principal will comply with all other requirements of the law and regulations regarding tax under section 4081.
The surety will be granted relief from liability under the bond at any time, provided the surety notifies the principal and the
Commissioner of the Internal Revenue Service in writing at least 60 days before the date on which the surety wants to be
relieved of liability. If the notice is given by an agent of the surety, the notice must be accompanied by a power of attorney or a
verified statement that a power of attorney is on file with the Commissioner.
If this notice is given, the principal’s rights under the bond will end on the date given in the notice, unless the notice is later
withdrawn in writing, or unless the principal’s rights are supported by other bonds. The surety will be relieved from any liability
for acts that occur after the date given in the notice but will remain liable for any unpaid tax and any penalties and interest
incurred by the principal before the bond was canceled, unless the principal pays the tax, penalties, and interest.

Part II

Signature

Under penalties of perjury, I declare that I have examined this form and any accompanying statements, and to the best of my knowledge and
belief, they are true, correct, and complete.

Signature of principal and surety

Signature of principal

Name (please type or print)

Date

Signature of surety

Name (please type or print)

Date

Part III

Approval by Commissioner

Bond approved

Registration No.
Date

Commissioner

Commissioner: Send copy of approval form to principal shown above.

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 16984Z

Form
2014)

928

(Rev. 10-

Page

Form 928 (Rev. 10-2014)

Paperwork Reduction Act
Notice
We ask for the information on this form
to carry out the Internal Revenue laws of
the United States. You are required to
give us the information. We need it to
ensure that you are complying with these
laws and to allow us to figure and collect
the right amount of tax.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping

1 hr., 55 min.

Learning about the law
or the form

18 min.

Preparing, copying,
assembling, and sending
the form to the IRS

20 min.

If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form
simpler, we would be happy to hear from
you. You can write to both the Internal
Revenue Service, Washington, DC
20224, Attention: IRS Reports Clearance
Officer, T:FP; and the Office of
Management and Budget, Paperwork
Reduction Project (1545-0725),
Washington, DC 20503. DO NOT file this
form with either of these offices. See
Where To File below.

General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.

Purpose of Form
Use this form to post bond required
under section 4101(b).

Who Must File
This form must be completed by any
person required by the Commissioner
to post bond as a condition of
registration on Form 637, Application for
Registration, (For Certain Excise Tax
Activities) for purposes of the federal
excise tax imposed under section 4081.

Where To File
File Form 928 in duplicate with the
Commissioner who required the posting
of the bond.

Qualifying Sureties
The surety on the bond must be listed in
the Department of the Treasury Circular
570 as an acceptable surety or reinsurer
on Federal bonds.

Amount of Bond
Taxable Fuel.— Generally, a bond
given under section 4101(b) must be in
an amount that the Commissioner
determines will ensure timely collection
of the taxes imposed by section 4081,
taking into account the applicant's
financial capabilities, tax history, and
expected liability under section 4081.
The Commissioner may increase or
decrease the amount of the required
bond to take into account changes in
the applicant’s, financial capabilities,
tax history, and expected liability under
section 4081. However, in no case
may the amount of the bond be greater
than the amount that the
Commissioner determines is equal to
—
(i) The applicant's expected tax liability
under section 4081 for a
representative 6-month period (as
determined by the Commissioner);
(ii) In the case of a terminal operator,
the expected tax liability of persons
other than the terminal operator under
section 4081 with respect to taxable
fuel removed at the racks of its
terminals (determined as if all
removals of taxable fuel were taxable)
during a representative 1-month period
(as determined by the Commissioner).
If the tax is not an even multiple of
$100, the bond must be increased to
the next higher multiple by $100.

Who May Sign as Principal
The bond must be signed by: (1) the
individual, if the applicant is an
individual, (2) the president, vice
president, or other principal officer, if the
applicant is a corporation, (3) a
responsible and authorized member or
officer having knowledge of the
organization’s affairs, if the applicant is a
partnership or other unincorporated
organization, and (4) the fiduciary, if the
applicant is a trust or estate.

Period of Bond
The liability stated on the bond is a
continuing one. It is not made for any
fixed period of time. If the quarterly
liability for excise tax that would be
imposed on gasoline, diesel fuel, or
kerosene is increased or decreased,
contact the Commissioner
immediately after the quarter to see if
a strengthening or superseding bond
is necessary.

2

The bond may also have to be changed
if there is a substantial change in
ownership or management of the
business.

Strengthening or
Superseding Bond
The Commissioner may require a
strengthening or superseding bond if:
(1) it is necessary to ensure collection of
the tax imposed under section 4081, or
(2) the tax on the volume of gasoline,
diesel fuel, or kerosene removed or sold
in any month is greater than the volume
on which the existing bond is based.
See Regulations section 48.4101-1(j) for
more details on strengthening and
superseding bonds for the excise tax on
taxable fuel.
A “strengthening bond” is an
additional bond you give to increase the
amount of your existing bond. A
“superseding bond” is a new bond that
takes the place of an existing bond. If
you do not submit a strengthening or
superseding bond when required, your
registration may be suspended or
revoked.
Superseding bond for reduced
volume.—If the average monthly volume
of gasoline, diesel fuel, or kerosene you
removed or sold during the most recent
12 consecutive months is less than 80%
of the volume used in computing your
existing bond, you may request the
Commissioner’s permission to give a
superseding bond. If you are a terminal
operator, apply this test to the average
monthly volume of gasoline, diesel fuel,
or kerosene that flowed through the
terminal during the most recent 12
consecutive months. If you are a blender
of taxable fuel, apply the test to the
average monthly gallons of taxable fuel
purchased during the most recent 12
consecutive months.