Form 6627 - Environmental Taxes
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36627
Environmental Taxes
Form
OMB No. 1545-0123
(Rev. January 2018)
Attach to Form 720.
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Department of the Treasury
Go to for the latest information.
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Internal Revenue Service
Name (as shown on Form 720)
Quarter ending
Employer identification number (EIN)
(a)
(b)
(c)
Reserved
Part I
Barrels
Rate
Tax
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Reserved for future use .
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2
Reserved for future use .
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3
Reserved for future use .
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4
Reserved for future use .
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5
Reserved for future use .
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Reserved for future use .
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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))
1
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. 1-2018)
Cat. No. 43490I
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