Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction

Download a blank fillable Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

6069
Return of Excise Tax on Excess Contributions to
OMB No. 1545-0049
Form
Black Lung Benefit Trust Under Section 4953 and
(Rev. February 2012)
NOT Open for
Computation of Section 192 Deduction
Department of the Treasury
Public Inspection
Internal Revenue Service
For calendar year
, or fiscal year beginning
, and ending
Employer identification number
Operator’s name
Number, street, and room or suite no. (or P. O. box number)
If address changed, check here
.
.
.
.
.
City or town, state and ZIP code
Name of related section 501(c)(21) trust
Employer identification number of related trust
Schedule A
Worksheet for Computing the Section 192 Deduction by Coal Mine Operators (See instructions)
1
Enter the amount necessary to fund (with level funding) the remaining unfunded liability for claims
filed or expected to be filed by, or on behalf of, past or present employees of the operator based on:
a The average remaining working life of miners currently employed
1a
b 10 tax years .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1b
c Any other funding period prescribed or approved by the Secretary
of the Treasury .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1c
d Enter the smaller of line 1a or 1b .
.
.
.
.
.
.
.
.
.
.
1d
e Enter the larger of line 1c or 1d .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1e
2 a Enter the amount necessary to carry out section 501(c)(21)(A)
purposes for the tax year .
.
.
.
.
.
.
.
.
.
.
.
.
.
2a
b Enter the fair market value of the trust’s assets (see instructions)
2b
c Subtract line 2b from line 2a (if less than zero, enter -0-)
2c
.
.
.
.
.
.
.
.
.
.
.
.
.
3
Maximum allowable deduction (enter the larger of line 1e or line 2c)
.
.
.
.
.
.
.
.
3
Schedule B
Computation of Section 4953 Tax by the Person Making Excess Contributions Under Section 192
to a Section 501(c)(21) Trust (See instructions)
1 a Contributions made to section 501(c)(21) trust for operator’s tax year
1a
b Operator’s maximum allowable deduction under section 192 for tax
year (enter amount from Schedule A, line 3)
.
.
.
.
.
.
.
1b
c Subtract line 1b from line 1a (if less than zero, enter -0-)
.
.
.
1c
2
Excess contributions carried over from the preceding tax year
.
2
3
Total (add lines 1c and 2)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
4
Amount that current year’s contributions are less than the
maximum amount deductible (subtract line 1a from line 1b) (if less
than zero, enter -0-)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
4
Amount of previous year’s excess contributions that were returned
5
to the contributor during the current tax year .
.
.
.
.
.
.
5
6
Total (add lines 4 and 5) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
6
7
Excess contributions for current year (subtract line 6 from line 3)(if less than zero, enter -0-) .
.
7
8
Tax due (enter 5% of line 7). Pay in full with return. .
.
.
.
.
.
.
.
.
.
.
.
.
.
8
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
Please
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
Title
Signature of person filing return
Date
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
Firm's address
Phone no.
6069
For Privacy Act and Paperwork Reduction Act Notice, see the back of the return.
Form
(Rev. 2-2012)
Cat. No. 12145E

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2