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Assessment and Abatement of Miscellaneous Civil Penalties
1. Taxpayer’s Name: Last, First, Middle Initial
5. Year
6. Statute Date
(single name only)
(mandatory)
(mandatory) (mmddyyyy)
2. Address
7.
-
-
(a) SSN:
or
(b) EIN:
-
3. MFT
:
IMF 55
BMF 13
4. “X” if no ASED:
8. Function
:
LMSB
SB/SE
W&I
TE/GE
Appeals
("x" one)
(“x” one)
CAUTION: FOR CORRECT LINE ITEM ENTRIES, FIRST IDENTIFY THE APPROPRIATE PENALTY CODE SECTION.
(a)
(b)
(c)
(d)
(e)
(f)
9. Item
Penalty Code
Penalty Description
Penalty Reference
Number of
Amount
Amount
Penalty
Section
Number
Violations
Assessed
Abated
Reason Code
G. Excise (IRM 20.1.10)
6675
Excessive claims with respect to the use of certain fuels
661
6715
Dyed fuel sold for use or used in taxable use, etc.
656
Tampering with or failing to maintain security requirements
6715A
665
for mechanical dye injection systems
6717
655
Refusal of entry or inspection - IRC sec. 4083(d)(1)
Failure to display tax registration on vessels - IRC sec.
6718
657
4101(a)(3)
6719
670
Failure to register/reregister - IRC sec. 4101(a)
6720A
673
Penalty with respect to certain adulterated fuels
6725
Failure to report a vessel/facility - IRC sec. 4101(d)
667
H. Other (IRM 20.1.10)
Failure to file certification with respect to certain residential
6652(j)
587
rental projects required under section 142(d)(7)
6652(k)
588
Failure to make reports required under sec. 1202
6652(l)
649
Failure to file Form 8806 - IRC sec. 6043(c)
6653
Willful failure to pay, evade or defeat stamp tax
574
6673(a)
Sanctions and costs awarded by Tax Court
643
6673(b)
Sanctions and costs awarded by other courts
644
Fraudulent statement or willful failure to furnish statement to
6674
575
employee – IRC sec. 6051 or 6053(b)
Penalty with respect to tax liability of regulated investment
6697
582
company
6702(a)
Frivolous tax return
666
Remarks:
10a. Originator
10b. Manager
11a. Date
11b. Date
12. Organization Code
13. Phone
14. Reviewer
15. Date
16. Terminal Operator
17. Date
8278
Catalog Number 62278G
Form
(Rev. 02-2010)