Form 2290 - Heavy Highway Vehicle Use Tax Return
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82290
Heavy Highway Vehicle Use Tax Return
Keep a copy of this
Form
return for your records.
For the period July 1, 2013, through June 30, 2014
(Rev. July 2013)
Attach both copies of Schedule 1 to this return.
Department of the Treasury
▶
OMB No. 1545-0143
Information about Form 2290 and its separate instructions is at
Internal Revenue Service (99)
▶
Employer identification number
Name
–
Address (number, street, and room or suite no.)
Type
or Print
City or town, state or province, country, and ZIP or foreign postal code
Check if applicable:
Address change
VIN Correction
Check this box if you are correcting a vehicle
identification number (VIN) listed on a previously filed
Amended Return
Schedule 1 (Form 2290). Do not check this box for any
Check this box if reporting (a) additional tax from an
other reason.
increase in taxable gross vehicle weight or (b) suspended
Final Return
vehicles exceeding the mileage use limit. Do not check
this box for any other reason.
Check this box if you no longer have taxable vehicles to
report.
Part I
Figuring the Tax
Y
Y
Y
Y
M
M
1
Was the vehicle(s) reported on this return used on public highways during July 2013? If YES,
enter 201307 in the boxes to the right. If NO, see the table on page 3 of the instructions .
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2
Tax. Enter the Total from Form 2290, page 2, column (4) .
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3
3
Additional tax from increase in taxable gross weight (see instructions) .
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4
Total tax. Add lines 2 and 3 .
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Credits (see instructions) .
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Balance due. Subtract line 5 from line 4. This is the amount you owe. If payment through
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EFTPS, check here
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Part II
Statement in Support of Suspension
(Complete the statements that apply. Attach additional sheets if needed.)
7
I declare that the vehicles reported on Schedule 1 as suspended (category W) are expected to be used on public highways
(check the boxes that apply):
5,000 miles or less
7,500 miles or less for agricultural vehicles
during the period July 1, 2013, through June 30, 2014, and are suspended from the tax. Complete and attach Schedule 1.
8 a I declare that the vehicles listed as suspended on the Form 2290 filed for the period July 1, 2012, through June 30, 2013, were
not subject to the tax for that period except for any vehicles listed on line 8b. Check this box if applicable.
▶
b Vehicle identification numbers
9
I declare that vehicle identification numbers
were listed as suspended on the Form 2290 filed for the period July 1, 2012, through June 30, 2013. These vehicles were sold or
,
on
transferred to
.
At the time of the transfer, the vehicles were still eligible for the suspension of the tax. Attach a separate list if needed.
Third
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following.
No
Party
Designee’s
Phone
Personal identification
Designee
name
no.
number (PIN)
▶
▶
▶
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
Type or print name below signature.
Telephone number
Preparer's signature
Date
Print/Type preparer’s name
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
▶
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Firm's address
Phone no.
▶
2290
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 7-2013)
Cat. No. 11250O
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