Form 11-C - Occupational Tax And Registration Return For Wagering Page 4
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Form 11-C (Rev. 12-2017)
Page
Supplemental Registration
Line 1. Enter the day and month that you will start
accepting wagers. A full month’s tax is due regardless of
Line 7. If you, as a principal, change your home or
which day you start accepting wagers during a month.
business address, you must file a supplemental
Line 2. Use the table below to determine the tax. The
registration before accepting wagers at the new address
$50 tax applies if all wagers (including those accepted by
or by the end of the 30-day period after the change,
an agent for another) are authorized under the laws of the
whichever occurs first. If you engage a new agent to
state in which accepted. If you intend to accept wagers
receive wagers, you must file, within 10 days of engaging
that aren’t authorized by the state, the $500 tax applies.
the agent, a supplemental registration reporting the
The tax is payable for the period that begins July 1 of
agent’s name, address, and EIN.
each year. If you start accepting wagers after July 31, the
You must file a supplemental registration within 30
tax is prorated for the first year.
days of the occurrence of any of the following events.
Note: This tax is paid once for each period that begins
• As the surviving spouse or child, executor,
July 1. If you’re required to file a supplemental
administrator, or other legal representative, you continue
registration, don’t pay the tax a second time.
for the remainder of the period the business of a
If you start
$500
$50
deceased person who paid the occupational tax.
accepting
tax
tax
• As a receiver, trustee in bankruptcy, or assignee for
wagers in
creditors, you continue the business for the remainder of
July . . . . . . . $500.00
. . . . $50.00
the period.
August . . . . . .
458.33
. . . .
45.83
• There is a change of members of a partnership which is
a principal.
September
. . . .
416.66
. . . .
41.66
• There is a name change of a corporation which is a
October
. . . . .
375.00
. . . .
37.50
principal.
November
. . . .
333.33
. . . .
33.33
Agents. You must complete line 7 if you have
December
. . . .
291.66
. . . .
29.16
previously filed Form 11-C and are engaged to receive
January
. . . . .
250.00
. . . .
25.00
wagers for another. You must register the name,
February . . . . .
208.33
. . . .
20.83
address, and EIN of each new person who engaged you
March . . . . . .
166.66
. . . .
16.66
within 10 days after being engaged.
April . . . . . . .
125.00
. . . .
12.50
How to file a supplemental registration. Complete the
May . . . . . . .
83.33
. . . .
8.33
name, address, EIN, business address, and alias lines.
June
. . . . . .
41.66
. . . .
4.16
• Check the “supplemental registration” box.
Payment voucher. Complete Form 11-C(V), Payment
• Check the applicable box on line 3 and enter the
Voucher, and file it with Form 11-C and your payment.
information that has changed on line 7, including the date
of the event of change.
Line 3. You must check one of the boxes. See Who must
file, earlier, for the definition of principal and agent.
• Don’t complete lines 1, 2, 4, 5, or 6 for a supplemental
Principals are liable for the excise tax on wagers, which is
registration.
reported and filed monthly on Form 730.
Paid Preparer Use Only
Lines 4 and 5. These lines are to be completed by
A paid preparer must sign Form 11-C and provide the
principals only. Enter applicable information for officers
information in the Paid Preparer Use Only section at the
and/or partners of the company on line 4. Enter on line
end of the form if the preparer was paid to prepare the
5a the name and address of each location where
form and isn’t an employee of the filing entity. The
business will be conducted. Enter the number of agents
preparer must give you a copy of the form in addition to
who accept wagers for you on line 5b and their names,
the copy to be filed with the IRS. If you’re a paid preparer,
addresses, and EINs on line 5c.
enter your Preparer Tax Identification Number (PTIN) in
Line 6. This line is to be completed by agents accepting
the space provided. Include your complete address. If
wagers on behalf of another. Enter the name, address,
you work for a firm, you also must enter the firm’s name
and EIN of each person or company on whose behalf you
and the EIN of the firm. However, you can’t use the PTIN
accept wagers.
of the tax preparation firm in place of your PTIN. You can
apply for a PTIN online or by filing Form W-12, IRS Paid
Preparer Tax Identification Number (PTIN) Application and
Renewal. For more information about applying for a PTIN
online, visit the IRS website at
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