Form 6627 - Environmental Taxes
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46627
Environmental Taxes
Form
OMB No. 1545-0245
(Rev. January 2013)
Information about Form 6627 and its instructions is available at
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Department of the Treasury
Attach to Form 720.
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Internal Revenue Service
Name (as shown on Form 720)
Quarter ending
Employer identification number
(a)
(b)
(c)
Tax on Petroleum
Part I
Barrels
Rate
Tax
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Crude oil received at a U.S. refinery .
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2
Crude oil taxed before receipt at refinery.
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3
Taxable crude oil. Subtract line 2 from line 1. Multiply column (a)
by column (b) and enter the amount of tax in column (c) .
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4
Crude oil used in or exported from the U.S. before the tax was
imposed. Multiply column (a) by column (b) and enter the
amount of tax in column (c) .
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Total domestic petroleum oil spill tax. Add lines 3 and 4,
column (c). Enter the total here and on Form 720 on the line for
IRS No. 18
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6
Imported petroleum products oil spill tax. Enter the number of
barrels imported in column (a). Multiply column (a) by column (b)
and enter the amount of tax in column (c). Also enter the amount
on Form 720 on the line for IRS No. 21 .
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Tax on Ozone-Depleting Chemicals (ODCs), IRS No. 98
Part II
Elections. If you elect to report the tax on post-1989 ODCs at the time you sell or use a mixture containing such chemicals
instead of when you make the mixture, check this box (the 1990 election) .
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If you elect to report the tax on post-1990 ODCs at the time you sell or use a mixture containing such chemicals instead of when
you make the mixture, check this box (the 1991 election) .
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(c)
(d)
(a)
(b)
Tax per pound
Tax (multiply column (b)
ODC
Number of pounds
(see Part II instructions)
by column (c))
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2
3
4
Total ozone-depleting chemicals tax. Add all amounts in column (d), include amounts from
any additional sheets. Enter the total here and on Form 720 on the line for IRS No. 98.
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6627
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 720.
Form
(Rev. 1-2013)
Cat. No. 43490I
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