Form 720 - Quarterly Federal Excise Tax Return Page 2
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72
Form 720 (Rev. 4-2013)
Page
Manufacturers Taxes
IRS No.
Number of tons
Sales price
Rate
Tax
IRS No.
36
36
$1.10 per ton
Coal—Underground mined
37
37
4.4% of sales price
38
38
$ .55 per ton
Coal—Surface mined
39
39
4.4% of sales price
Tax
Number of tires
IRS No.
Taxable tires other than bias ply or super single tires
108
108
109
Taxable bias ply or super single tires (other than super single tires designed for steering)
109
113
Taxable tires, super single tires designed for steering
113
. . . . .
40
Gas guzzler tax. Attach Form 6197. Check if one-time filing
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40
97
Vaccines (see instructions)
97
Sales price
2.3% of sales price
136
Taxable medical devices
136
1
Total. Add all amounts in Part I. Complete Schedule A unless one-time filing
$
▶
Part II
IRS No.
Patient-Centered Outcomes Research Fee (see
(a) Avg. number
(b) Rate for avg.
instructions)
of lives covered
covered life
Tax
Col. (a) x Col. (b)
IRS No.
}
Specified health insurance policies
$1.00
133
133
Applicable self-insured health plans
$1.00
Rate
41
Sport fishing equipment (other than fishing rods and fishing poles)
41
10% of sales price
110
Fishing rods and fishing poles (limits apply, see instructions)
110
10% of sales price
42
42
Electric outboard motors
3% of sales price
114
Fishing tackle boxes
114
3% of sales price
44
Bows, quivers, broadheads, and points
44
11% of sales price
106
Arrow shafts
106
$ .48 per shaft
140
Indoor tanning services
140
10% of amount paid
Number of gallons
Rate
Tax
64
Inland waterways fuel use tax
64
$ .20
125
LUST tax on inland waterways fuel use (see instructions)
125
.001
51
51
Alcohol and cellulosic biofuel sold as but not used as fuel
117
Biodiesel sold as but not used as fuel
117
Floor Stocks Tax— Ozone-depleting chemicals (floor stocks). Attach Form 6627.
20
20
$
2
Total. Add all amounts in Part II
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Part III
3
Total tax. Add Part I, line 1, and Part II, line 2 .
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4
Claims (see instructions; complete Schedule C)
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4
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5
5
Deposits made for the quarter .
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Check here if you used the safe harbor rule to make your deposits.
6
Overpayment from previous quarters .
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6
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Enter the amount from Form 720X included
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on line 6, if any .
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7
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8
Add lines 5 and 6 .
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8
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9
9
Add lines 4 and 8 .
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10
Balance Due. If line 3 is greater than line 9, enter the difference. Pay the full amount with the return (see instructions)
10
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11
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.
11
Third Party
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following.
No
Designee
Designee name
Phone no.
Personal identification number (PIN)
▶
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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
Signature
Date
Title
Type or print name below signature.
Telephone number
▶
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Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
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Firm's address
Phone no.
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720
Form
(Rev. 4-2013)
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