Form 11-C - Occupational Tax And Registration Return For Wagering Page 4
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Form 11-C (Rev. 12-2013)
Page
Line 1. Enter the day and month that you will start
Line 6. This line is to be completed by agents accepting
accepting wagers. A full month’s tax is due regardless of
wagers on behalf of another. Enter the name, address,
which day you start accepting wagers during a month.
and EIN of each person or company on whose behalf you
accept wagers.
Line 2. Use the table below to determine the tax. The
Supplemental Registration
$50 tax applies if all wagers (including those accepted by
an agent for another) are authorized under the laws of the
Line 7. If you, as a principal, change your home or
state in which accepted. If you intend to accept wagers
business address, you must file a supplemental
that are not authorized by the state, the $500 tax applies.
registration before accepting wagers at the new address
The tax is payable for the period that begins July 1 of
or by the end of the 30-day period after the change,
each year. If you start accepting wagers after July 31, the
whichever occurs first. If you engage a new agent to
tax is prorated for the first year.
receive wagers, you must file, within 10 days of engaging
Note. This tax is paid once for each period that begins
the agent, a supplemental registration reporting the
agent's name, address, and EIN.
July 1. If you are required to file a supplemental
registration, do not pay the tax a second time.
You must file a supplemental registration within 30
days of the occurrence of any of the following events.
If you start
$500
$50
• As the surviving spouse or child, executor,
accepting
tax
tax
wagers in
administrator, or other legal representative, you continue
for the remainder of the period the business of a
July . . . . . . . $500.00
. . . . $50.00
deceased person who paid the occupational tax.
August . . . . . .
458.33
. . . .
45.83
• As a receiver, trustee in bankruptcy, or assignee for
September
. . . .
416.66
. . . .
41.66
creditors, you continue the business for the remainder of
October
. . . . .
375.00
. . . .
37.50
the period.
November
. . . .
333.33
. . . .
33.33
• There is a change of members of a partnership which is
December
. . . .
291.66
. . . .
29.16
a principal.
January
. . . . .
250.00
. . . .
25.00
• There is a name change of a corporation which is a
February . . . . .
208.33
. . . .
20.83
principal.
March . . . . . .
166.66
. . . .
16.66
Agents. You must complete line 7 if you have
April . . . . . . .
125.00
. . . .
12.50
previously filed Form 11-C and are engaged to receive
wagers for another. You must register the name,
May . . . . . . .
83.33
. . . .
8.33
address, and EIN of each new person who engaged you
June
. . . . . .
41.66
. . . .
4.16
within 10 days after being engaged.
Payment voucher. Complete Form 11-C(V), Payment
How to file a supplemental registration. Complete the
Voucher, and file it with Form 11-C and your payment.
name, address, EIN, business address, and alias lines.
Line 3. You must check one of the boxes. See Who must
• Check the "supplemental registration" box.
file for the definition of principal and agent. Principals are
• Check the applicable box on line 3 and enter the
liable for the excise tax on wagers, which is reported and
information that has changed on line 7, including the date
filed monthly on Form 730.
of the event of change.
Lines 4 and 5. These lines are to be completed by
• Do not complete lines 1, 2, 4, 5, or 6 for a supplemental
principals only. Enter applicable information for officers
registration.
and/or partners of the company on line 4. Enter on line
5a the name and address of each location where
business will be conducted. Enter the number of agents
who accept wagers for you on line 5b and their names,
addresses, and EINs on line 5c.
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