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Where To File

later adjusted by an amended return, a claim for refund, or an

examination, or to make certain elections after the prescribed

deadline (see Regulations sections 301.9100-1 through -3).

Use Form 720X, Amended Quarterly Federal Excise Tax

IF you are filing Form 843...

THEN mail the form to...

Return, to make adjustments to liability reported on Forms 720

In response to an IRS notice

The address shown in the notice.

you have filed for previous quarters. Do not use Form 720X to

regarding a tax or fee related to

make changes to claims made on Schedule C (Form 720),

certain taxes such as income,

except for the section 4051(d) tire credit and section 6426 fuel

employment, gift, estate,

credits.

excise, etc.

Use Form 730, Monthly Tax Return for Wagers, to claim a

For penalties, or for any other

The service center where you would be

credit or refund of wagering tax.

reason other than an IRS notice

required to a file a current year tax return for

Use Form 4136, Credit for Federal Tax Paid on Fuels, to claim

(see above) or Letter 4658 (see

the tax to which your claim or request

a credit against your income tax for certain nontaxable uses (or

below)

relates. See the instructions for the return

sales) of fuel during the income tax year. Also, use Form 4136 if

you are filing.

you are a producer claiming a credit for alcohol fuel mixtures or

In response to Letter 4658

Internal Revenue Service

biodiesel mixtures. However, you can use Form 8849, Claim for

(notice of branded prescription

Mail Stop 4921 BPDF

Refund of Excise Taxes, to claim a periodic refund instead of

drug fee)

1973 N. Rulon White Blvd.

waiting to claim an annual credit on Form 4136.

Ogden, UT 84404

Use Form 8849, Claim for Refund of Excise Taxes, to claim a

Note. To ensure proper

refund of excise taxes other than those resulting from

processing, write “Branded

Caution. Use this address only if you are

Prescription Drug Fee” across

claiming a refund of the branded

adjustments to your reported liabilities. See IRS Pub. 510,

the top of Form 843.

prescription drug fee.

Excise Taxes, for the appropriate forms to use to claim excise

tax refunds.

For requests of a net interest

The service center where you filed your

Corporations (other than S corporations) can use Form 1139,

rate of zero

most recent return.

Corporation Application for Tentative Refund, to apply for a

Penalty for Erroneous Claim for

“quick refund” of taxes from an overpayment of tax due to a

claim of right adjustment under section 1341(b)(1), or the

Refund

carryback of an NOL, a net capital loss, or an unused general

business credit.

If you claim an excessive amount of tax refund or credit relating

to income tax (other than a claim relating to the earned income

Separate Form Required

credit), you may be liable for a penalty of 20% of the amount

determined to be excessive. An excessive amount is the amount

Generally, you must file a separate Form 843 for each tax period

or fee year or type of tax or fee. There are exceptions for certain

of the claim for refund or credit that is more than the amount of

claims. See the instructions for line 5.

claim allowable for the tax year. The penalty may be waived if

you can show that you had a reasonable basis for making the

Generally, you must file a claim for a credit or refund within 3

claim.

years from the date you filed your original return or 2 years from

Paid Tax Return Preparer

the date you paid the tax, whichever is later. If you do not file a

claim within this period, you may no longer be entitled to a credit

A paid tax return preparer who files Form 843 for you must sign

or refund. See Pub. 556, Examination of Returns, Appeal Rights,

the form and fill in the identifying information at the bottom of the

and Claims for Refund, for more information. But note below the

form. The tax preparer must give you a copy of the completed

instructions for when to file a request for abatement or refund of

Form 843 for your records. Someone who prepares your Form

a penalty or an addition to tax as a result of erroneous written

843 but does not charge you should not sign it.

advice.

Who Can File

Specific Instructions

You can file Form 843 or your authorized representative can file

Social security number. Enter your social security number

it for you. If your authorized representative files Form 843, the

(SSN). If you are filing Form 843 relating to a joint return, enter

original or copy of Form 2848, Power of Attorney and

the SSNs for both you and your spouse.

Declaration of Representative, must be attached. You must sign

Form 2848 and authorize the representative to act on your

Line 1

behalf for the purposes of the request. See the Instructions for

Form 2848 for more information.

Enter the tax period for which you are making the claim for

refund or request for abatement. If you are requesting a refund of

If you are filing as a legal representative for a decedent

a branded prescription drug fee, enter the fee year on the “From”

whose return you filed, attach to Form 843 a statement that you

line.

filed the return and you are still acting as the decedent's

Line 3

representative. If you did not file the decedent's return, attach

certified copies of letters testamentary, letters of administration,

Check the appropriate box to show the type of tax or fee for

or similar evidence to show your authority. File Form 1310,

which you are claiming a refund or requesting an abatement. If

Statement of Person Claiming Refund Due a Deceased

the claim relates to interest, a penalty, or addition to tax, check

Taxpayer, with Form 843 if you are the legal representative of a

the box to indicate the type of tax to which the claim or request

decedent.

relates.

Do not use Form 843 when another tax form must be

used. See Purpose of Form.

CAUTION

Excess tier 2 RRTA tax. Complete lines 1 and 2. On line 3,

check the box for “Employment” tax. Skip lines 4, 5, and 6. On

-2-

Instructions for Form 843 (Rev. December 2013)

Instructions For Form 843 (Rev. December 2013) (For Use With Form 843 (Rev. August 2011)) - Claim For Refund And Request For Abatement Page 3

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