Form 720 Quarterly Federal Excise Tax

720

Quarterly Federal Excise Tax Return

Form
(Rev. April 2017)
Department of the Treasury
Internal Revenue Service

Check here if:
Final return
Address change

OMB No. 1545-0023

See the Instructions for Form 720.
▶ Information about Form 720 and its separate instructions is at www.irs.gov/form720.
▶

FOR IRS USE ONLY

Name

Quarter ending

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

Employer identification number

T
FF
FD
FP
I

City or town, state or province, country, and ZIP or foreign postal code

T

Part I
IRS No.

18
21
98
19
22
26
28
27

60

104
105
107
119
35
69
77
111
79
62
13
14
112
118
120
121
122
123
124

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, tax on removal at terminal rack
(b) Diesel, tax on taxable events other than removal at terminal rack
(c) Diesel, tax on sale or removal of biodiesel mixture
(not at terminal rack)
Diesel-water fuel emulsion
Dyed diesel, 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
Other fuels (see instructions)
(a) Gasoline, tax on removal at terminal rack
(b) Gasoline, tax on taxable events other than removal at terminal rack
Any liquid fuel used in a fractional ownership program aircraft
Aviation gasoline
Liquefied petroleum gas (LPG) (see instructions)
“P Series” fuels
Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen
Fischer-Tropsch process liquid fuel from coal (including peat)
Liquid fuel derived from biomass
Liquefied natural gas (LNG) (see instructions)

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

Tax

IRS No.

18
21
98
19
Tax

22
26
28
27
Rate

$.244
.244
.244
.198
.001
.001
.001
.244
.244
.219
.044
.001
.184
.184
.141
.194
.183
.184
.183
.184
.244
.244
.243
Cat. No. 10175Y

}
}
}

Tax

60

104
105
107
119
35
69
77
111
79
62
13
14
112
118
120
121
122
123
124
Form 720 (Rev. 4-2017)

Form 720 (Rev. 4-2017)

Page
Rate

IRS No.

Tax

12% of sales tax
Retail Tax—Truck, trailer, and semitrailer chassis and bodies, and tractor
Number of persons
Rate
Ship Passenger Tax
$3 per person
Transportation by water
Amount of obligations
Rate
Other Excise Tax
$ .01
Obligations not in registered form

33
29
31

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

Life insurance, sickness and accident policies, and annuity
contracts
Reinsurance
Number of tons
Manufacturers Taxes

30

36
37
38
39

Premiums paid

Rate

$ .04
.01
.01

33
Tax

29
Tax

31
Tax

}

IRS No.

30

Sales price

36
37
38
39

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

Coal—Underground mined
Coal—Surface mined

Tax

Number of tires

108
109
113
40
97

2

IRS No.

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)

IRS No.

108
109
113
40
97

. . . . .

Sales price

136 Reserved
1 Total. Add all amounts in Part I. Complete Schedule A unless one-time filing

2.3% of sales price
▶

136
$

Part II
IRS No.

133

Patient‐Centered Outcomes Research Fee (see
instructions)
Specified health insurance policies

(a) Avg. number
of lives covered
(see inst.)

(b) Rate for
avg.
covered life

(a) With a policy year ending before October 1, 2016

$ 2.17

(b) With a policy year ending on or after October 1, 2016,
and before October 1, 2017

$ 2.26

(c) Fee (see
instructions)

}

Applicable self‐insured health plans
(c) With a plan year ending before October 1, 2016

$ 2.17

(d) With a plan year ending on or after October 1, 2016, and
before October 1, 2017

$ 2.26

Tax

IRS No.

133

Rate

41
110
42
114
44
106
140

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

10% of sales price
10% of sales price
3% of sales price
3% of sales price
11% of sales price
$ .50 per shaft
10% of amount paid
Number of gallons

64 Inland waterways fuel use tax
125 LUST tax on inland waterways fuel use (see instructions)
51 Section 40 fuels (see instructions)
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

41
110
42
114
44
106
140

Rate

Tax

64
125
51
117
20

$ .29
.001

▶

$
Form 720 (Rev. 4-2017)

Form 720 (Rev. 4-2017)

Page

3

Part III
3
4
5
6
7
8
9
10
11

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

9
10

▶

11
No

Personal identification number (PIN) ▶

Signature

Date

Type or print name below signature. ▶
Print/Type preparer’s name

Preparer’s signature

▲

Paid
Preparer
Use Only

▶

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

Phone no. ▶

3

Yes. Complete the following.

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

▶

Title

Telephone number ▶
Date
PTIN
Check
if
self-employed

Firm’s name

▶

Firm’s EIN

Firm’s address

▶

Phone no.

▶

Form 720 (Rev. 4-2017)

Form 720 (Rev. 4-2017)

Schedule A

Page

4

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
1st–15th day

.

.

.

.

.

.

16th–last day

.

.

▶

B
D
F
G

(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
1st–15th day
Collected
First month
M
Second month
O
Third month
Q
Special rule for September* .

.

.

.

.

.

.

.

Period
16th–last day

.

▶

N
P
R
S

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

Schedule T

Two-Party Exchange Information Reporting (see instructions)

Fuel
Diesel fuel, gallons received in a two-party exchange within a terminal, included
on IRS No. 60(a) on Form 720

Number of gallons

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. 4-2017)

Form 720 (Rev. 4-2017)

Page

5

Schedule C
Claims
Month your income tax year ends ▶
• 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 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

Note: CRN is credit reference number.
Type of use

Type of use

3

4

5

Amount of claim

CRN

Rate

Gallons

362
411
Amount of claim

Rate

Gallons

CRN

354
324
412
433

.

.

.

Amount of claim

$
$.243
.243
.17
.243
.244
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type of use

Rate

Gallons

360
353
350
360
413

.

.

Amount of claim

$
$.243
.17
.243
.244
.043
.218
Period of claim ▶

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
Kerosene Used in Aviation (see Caution above line 1)
Type of use

Rate

Gallons

▶

CRN

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)

Caution: Claims cannot be made on line 4 for kerosene sales from a blocked pump.

a
b
c
d
e
f

Gallons

$
Used in commercial aviation (other than foreign trade)
$.15
.193
Other nontaxable use (see Caution above line 1)
Exported (see Caution above line 1)
.194
.001
LUST tax on aviation fuels used in foreign trade
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

a
b
c
d
e

Rate

$
$.183
.184
Period of claim ▶

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

Period of claim ▶

.

▶

CRN

346
347
346
414
377
369
Amount of claim

CRN

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
d Nontaxable use (other than use by state or local
government) taxed at $.219
e LUST tax on aviation fuels used in foreign trade

$.200

$

417

.175

355

.243

346

.218
.001

369
433
Form 720 (Rev. 4-2017)

Form 720 (Rev. 4-2017)

6

Page

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 instructions).
Type of use

a
b
c
d
e
f
g
h

Liquefied petroleum gas (LPG) (see instructions)
“P Series” fuels
Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen
Fischer-Tropsch process liquid fuel from coal (including peat)
Liquid fuel derived from biomass
Liquefied natural gas (LNG) (see instructions)
Liquefied gas derived from biomass

Rate

Gallons, or gasoline
or diesel gallon
equivalents

Amount of claim
$

$.183
.183
.183
.183
.243
.243
.243
.183

CRN

419
420
421
422
423
424
425
435

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

7

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Rate

Gallons

Amount of claim

CRN

$
a Use by a state or local government
360
$.243
b Use in certain intercity and local buses
.17
350
8
Sales by Registered Ultimate Vendors of Undyed Kerosene
Period of claim ▶
(Other Than Kerosene For Use in Aviation)
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

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

Amount of claim

Gallons
$

$.243
.243
.17

CRN

346
347

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

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

Rate

Gallons

Amount of claim
$

$.175
.200
.025
.243
.218
.001

CRN

355
417
418
346
369
433

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

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

$.183
.183

Gallons

Amount of claim
$

CRN

362
Form 720 (Rev. 4-2017)

Form 720 (Rev. 4-2017)

11

Page

7

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.
▶

Rate

a Use by a nonprofit educational organization
b Use by a state or local government
12
Biodiesel or Renewable Diesel Mixture Credit Period of claim ▶

Gallons

Amount of claim
$

$.193
.193

CRN

324

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.

Caution: As of the publishing of this form, these credits expired for fuel sold or
used after December 31, 2016. Don't use line 12 unless they've been extended.
See IRS.gov/Form720.
a
b
c
13

Biodiesel (other than agri-biodiesel) mixtures
Agri-biodiesel mixtures
Renewable diesel mixtures
Alternative Fuel Credit and Alternative Fuel Mixture Credit

Rate

Gal. of biodiesel or
renewable diesel

Amount of claim
$

$1.00
1.00
1.00

CRN

388
390
307

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.

Caution: As of the publishing of this form, these credits expired for fuel
sold or used after December 31, 2016. Don't use line 13 unless they've
been extended. See IRS.gov/Form720.

Rate

Gallons, or
gasoline or diesel
gallon equivalents
(see instructions)

Amount of claim

CRN

a
b
c
d
e
f
g
h
i
14
a
b
c
d
e

$
Liquefied petroleum gas (LPG)
$.50
"P Series" fuels
.50
Compressed natural gas (CNG)
.50
Liquefied hydrogen
.50
Fischer-Tropsch process liquid fuel from coal (including peat)
.50
Liquid fuel derived from biomass
.50
.50
Liquefied natural gas (LNG)
.50
Liquefied gas derived from biomass
.50
Compressed gas derived from biomass
Amount of claim
Other claims. See the instructions. For lines 14b and 14c, see the Caution above line 1 on page 5.
$
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

426
427
428
429
430
431
432
436
437

f
g
h
i
j
k
15

Taxable tires other than bias ply or super single tires
Taxable tires, bias ply or super single tires (other than super single tires designed for steering)
Taxable tires, super single tires designed for steering

Number of tires

Total claims. Add amounts on lines 1 through 14. Enter the result here and on Form 720, Part III, line 4.

Amount of claim
$

CRN

366
415
416

CRN

396
304
305

15
Form 720 (Rev. 4-2017)

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.

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 (EINs)” link. You may also apply
for an EIN by faxing or mailing 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.

720-V

Form 720-V (2017)
▼

Payment Voucher

Department of the Treasury
Internal Revenue Service

1

Box 2. Enter the amount paid from line 10 of Form 720.
Box 3. Darken the circle identifying the quarter for which
the payment is made. Darken only one circle.
Box 4. Enter your name and address as shown on
Form 720.
• Enclose your check or money order made payable to
“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 in the
Instructions for Form 720.

▶

OMB No. 1545-0023

Dollars

Enter the amount of your payment.

▶

Make your check or money order payable to “United States Treasury.”
4

3 Tax Period

2017

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

Enter your employer identification
number (EIN) (see instructions).

Enter your business name (individual name if sole proprietor).

1st
Quarter

3rd
Quarter

Enter your address.

2nd
Quarter

4th
Quarter

City or town, state or province, country, and ZIP or foreign postal code.

Cents