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Occupational Tax and Registration Return for Wagering Form 11-C ▶ (Rev. December 2012) Information about Form 11-C and its instructions is available at www.irs.gov/form11c. OMB No. 1545-0236 Department of the TreasuryReturn for period from , to June 30, Internal Revenue Service (Month and day) (Year) (Year) Name Employer identification number Type Number, street, and room or suite no. or Print City, state, and ZIP code Check one: First return Renewal return Daytime telephone number Supplemental registration (Do not complete lines 1, 2, 4, 5, and 6.) Business address (if different from your home address or address entere d above) For IRS Use Only T $ 1 FF 2 Alias, style, or trade name, if any FP 3 I 4 Part I Occupational Tax T $ 5 1 Enter the date (month and day) you will start accepting wagers during the tax period. . . 2 Tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . $ See Form 11-C(V), Payment Voucher, for how to make your payments. 3 Check one: Principal Agent accepting wagers for another (see instructions) Part II Additional Information (for principal only) 4 If the taxpayer is a firm, partnership, or corporation, give the true na me of each member or officer. True name Title Home address Social security number 5 Are you or will you be engaged in the business of accepting wagers on yo ur own account?. . . . . Yes No If “Yes,” complete a, b, and c. a Name and address where each business is or will be conducted: Name of location Address (number and street) City, state, and ZIP code b Number of agents engaged in receiving wagers on your behalf ▶ c True name, address, and employer identification number of each agent: True name Address Employer identification number For Privacy Act and Paperwork Reduction Act Notice, see page 6. Cat. No. 16166V Form 11-C (Rev. 12-2012) Form 11-C (Rev. 12-2012) Page2 Part III Additional Information (for agents accepting wagers on behalf of others) 6 If you receive or will be receiving wagers on behalf of or as an agent for some other person or persons, give the true name, address, and employer identification number of each person. True name Address Employer identification number Part IV Supplemental Registration (see instructions) 7 Explain why you are filing a supplemental registration. Include the date of the event. Under penalties of perjury, I declare that I have examined this return a nd/or registration (including any accompanying statements or lists), a nd 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 Sign knowledge. Here ▲ ▲ Signature of officer Date Title Print/Type preparer’s name Preparer's signature Date PTIN Paid Check if self-employed Preparer Firm’s name▶ Firm's EIN Use Only Firm's address Phone no. Form11-C (Rev. 12-2012) Form 11-C (Rev. 12-2012) Page3 Section references are to the Internal Revenue Code Definitions. See the Instructions for Form 730, Monthly unless otherwise noted. Tax Return for Wagers, for the definition of sports event, contest, wagering pool, and lottery. Future developments. The IRS has created a page on IRS.gov for information about Form 11-C and its When to file. File the first return before wagers are instructions at www.irs.gov/form11c. Information about accepted. After that, file a renewal return by July 1 for any future developments affecting Form 11-C (such as each year wagers are accepted. A first return is also due legislation enacted after we release it) will be posted on in certain situations in which there has been a change in that page. ownership or control. The return must be filed within 30 days after new members are admitted to a firm or General Instructions partnership, a corporation is formed to continue the Purpose of form. Form 11-C is used to register certain business of a partnership, or a stockholder continues the information with the IRS and to pay the occupational tax business of a dissolved corporation. on wagering. You must pay the occupational tax if you Employer Identification Number (EIN). Enter your EIN. If accept taxable wagers for yourself or another person. you do not have an EIN, apply for one online. Go to the There are two amounts of occupational tax ($50 or $500). IRS website at www.irs.gov/businesses/small and click on One or the other applies depending on whether the the “Employer ID Numbers” link. You may also apply for wagers you accept are authorized by the laws of the state an EIN by calling 1-800-829-4933, or you can fax or mail in which you accept the wager. See Line 2 on page 4 to Form SS-4, Application for Employer Identification determine your occupational tax. Your cancelled check is Number, to the IRS. proof of registration and payment. Address. If you are an individual, enter your home Who must file. File Form 11-C if you are a principal or an address. agent. Signature. Form 11-C must be signed by a person who 1. A principal is a person who is in the business of has authority to sign for the taxpayer. accepting taxable wagers for his or her own account. Where to file. Mail Form 11-C, your check or money This is the person who makes a profit or risks loss order, and Form 11-C(V) to: depending on the outcome of the event or contest for which the wager is accepted. Department of the Treasury Internal Revenue Service 2. An agent is a person who accepts taxable wagers Cincinnati, OH 45999-0101 on the principal’s behalf. Mail the return using the U.S. Postal Service or other Taxable wagers include those placed: designated private delivery service. See the instructions • On a sports event or contest with a person engaged in for your income tax return for more information about the business of accepting wagers on a sports event or private delivery services. contest. Penalties. There are penalties for not filing on time, for • In a wagering pool on a sports event or contest if the accepting wagers before paying the tax, and for willfully pool is conducted for profit. failing to file the return. There are also penalties for making or helping to make false returns, documents, or • In a lottery conducted for profit (other than a state- statements. conducted lottery). The term lottery includes the numbers game, policy, punch boards, and similar types of If you receive a notice about penalty after you file this wagering. return, reply to the notice with an explanation and we will determine if you meet reasonable-cause criteria. Do not What is not taxed. The tax is not imposed on the attach an explanation when you file your return. following five items. Disclosure of information on wagering taxes. Except • A parimutuel wagering enterprise, including horse for administering or enforcing Internal Revenue taxes, racing, dog racing, and jai alai, when licensed under the neither the Treasury Department nor any of its laws of the state in which accepted; employees may disclose documents, records, or information obtained through them that a taxpayer • Coin-operated devices, such as pinball machines; • Sweepstakes, wagering pools, or lotteries that are supplies in connection with wagering taxes. Also, certain conducted by an agency of a state, if the wager is placed documents related to wagering taxes and information with the state agency or its authorized agents or obtained through them that relates to wagering taxes may employees; not be used against the taxpayer in any nontax criminal proceeding. See section 4424 for more details. • Games of the type in which usually all persons placing Refund. A refund for an overpayment of the occupational wagers in the game are present when wagers are placed, tax may be claimed on Form 8849, Claim for Refund of winners are determined, and prizes or other property are distributed; and Excise Taxes, using Schedule 6. See the Instructions for • Drawings conducted by an organization exempt from Form 8849 for details. tax under sections 501 or 521, as long as the net Specific Instructions proceeds of the drawing do not inure to the benefit of a Return period. Enter the month, day, and year the return private shareholder or individual. period begins. Also, enter the ending year. Write the year as a four-digit number (for example, 2012 or 2013). Form 11-C (Rev. 12-2012) Page4 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 Line 2. Use the table below to determine the tax. The accept wagers. $50 tax applies if all wagers (including those accepted by Supplemental Registration an agent for another) are authorized under the laws of the state in which accepted. If you intend to accept wagers Line 7. A supplemental registration must be filed by that are not authorized by the state, the $500 tax applies. principals within 30 days (except for items 1 and 7 below) The tax is payable for the period that begins July 1 of when any of the following events occur. 1. You change your business or home address. You each year. If you start accepting wagers after July 31, the must register the change before accepting wagers at the tax is prorated for the first year. new address or by the end of the 30-day period after the Note. This tax is paid once for each period that begins change of address, whichever occurs first. July 1. If you are required to file a supplemental 2. You continue for the remainder of the period, as the registration, do not pay the tax a second time. surviving spouse or child, executor, administrator, or If you start $500 $50 other legal representative, the business of a deceased accepting tax tax person who paid the occupational tax. wagers in 3. You continue for the remainder of the period the business as a receiver or trustee in bankruptcy. July . . . . . . . $500.00 . . . . $50.00 August . . . . . . 458.33 . . . . 45.83 4. You continue for the remainder of the period the September . . . . 416.66 . . . . 41.66 business as an assignee for creditors. October . . . . . 375.00 . . . . 37.50 5. One or more members withdraws from a firm or partnership. November . . . . 333.33 . . . . 33.33 December . . . . 291.66 . . . . 29.16 6. The corporate name is changed. January . . . . . 250.00 . . . . 25.00 7. You engage a new agent to receive wagers. You February . . . . . 208.33 . . . . 20.83 must file a supplemental registration to report the name, address, and EIN of each new agent within 10 days after March . . . . . . 166.66 . . . . 16.66 you engage the agent. April . . . . . . . 125.00 . . . . 12.50 May . . . . . . . 83.33 . . . . 8.33 Agents. You must complete line 7 if you have June . . . . . . 41.66 . . . . 4.16 previously filed Form 11-C and are engaged to receive wagers for another. You must register the name, Payment voucher. Complete Form 11-C(V), Payment address, and EIN of each new person who engaged you Voucher, and file it with Form 11-C and your payment. within 10 days after being engaged. Line 3. You must check one of the boxes. See Who must How to file a supplemental registration. Complete the file for the definition of principal and agent. Principals are liable for the excise tax on wagers, which is reported and name, address, EIN, business address, and alias lines. filed monthly on Form 730. Also, be sure to check the “supplemental registration” box. Then check the applicable box on line 3 and enter Lines 4 and 5. These lines are to be completed by the information that has changed on line 7, including the principals only. Enter applicable information for officers date of the event of change. Do not complete lines 1, 2, 4, and/or partners of the company on line 4. Enter on line 5, or 6 for a supplemental registration. 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. Form 11-C(V), Payment Voucher Purpose of Form Box 2. Enter the amount paid with Form 11-C. Complete Form 11-C(V), Payment Voucher, and file it Box 3. Enter the same year and month you entered on with Form 11-C, Occupational Tax and Registration the “Return for period from” line at the top of Form 11-C. Return for Wagering. We will use Form 11-C(V) to credit For example, if your return is for the full period that begins July 1, 2012, enter 201207. your payment more promptly and accurately, and to improve our service to you. Box 4. Enter your name and address as shown on Form If you have your return prepared by a third party, 11-C. provide Form 11-C(V) to the return preparer. • Enclose your check or money order made payable to the “United States Treasury.” Be sure to enter your EIN, Specific Instructions “Form 11-C,” and the tax period on your check or money Box 1. If you do not have an EIN, apply for one online. order. Do not send cash. Do not staple Form 11-C(V) or Go to the IRS website at www.irs.gov/businesses/small your payment to Form 11-C (or to each other). and click on the “Employer ID Numbers” link. You may • Detach Form 11-C(V) and send it with your payment also apply for an EIN by calling 1-800-829-4933, or you can fax or mail Form SS-4, Application for Employer and Form 11-C. See Where to file on page 3. Identification Number, to the IRS. ▼ ▼ Detach Here and Mail With Your Payment and Form 11-C. 11-C(V) Form Payment Voucher OMB No. 1545-0235 (Rev. December 2012) Internal Revenue Servicery ▶ Do not staple or attach this voucher to your payment or Form 11-C. 1 Enter your employer identification 2 Dollars Cents number. Enter the amount of your payment. ▶ Make your check or money order payable to “United States Treasury” 3 Enter year and month as shown on Form 11-4. Enter your business name (individual name if sole proprietor). Y Y Y Y M M Enter your address. Send Form 11-C, this voucher, and payment to: Department of the Treasury Enter your city, state, and ZIP code. Cincinnati, OH 45999-0101 Form 11-C (Rev. 12-2012) Page 6 Privacy Act and Paperwork Reduction You are not required to provide the information requested on a form that is subject to the Paperwork Act Notice Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its We ask for the information on Form 11-C to carry out the instructions must be retained as long as their contents Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure may become material in the administration of any Internal that you are complying with these laws and to allow us to Revenue law. Generally, tax returns and return figure and collect the right amount of tax. Section 4411 information are confidential, as required by section 6103. imposes a special tax on each person who is engaged in The time needed to complete and file this form will receiving wagers for or on behalf of any person liable for vary depending on individual circumstances. The the tax on wagers. Section 4412 requires that person to estimated average time is: Recordkeeping, 3 hrs., 49 register with the IRS. Form 11-C is used to determine the amount of the tax you owe and to register certain min.; Learning about the law or the form, 57 min.; information with the IRS. Section 6109 requires you to Preparing the form, 2 hrs., 0 min.; and Copying, provide your identification number. Unless specifically assembling, and sending the form to the IRS, 16 min. prohibited by law, routine uses of this information include giving it to the Department of Justice for civil and criminal If you have comments concerning the accuracy of litigation; to cities, states, the District of Columbia, and these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can U.S. commonwealths and possessions for use in write to: administering their tax laws; to other countries under a Internal Revenue Service tax treaty; to federal and state agencies to enforce federal Tax Products Coordinating Committee nontax criminal laws; or to federal law enforcement and SE:W:CAR:MP:T:M:S intelligence agencies to combat terrorism. If you fail to IR-6526 provide this information in a timely manner, you may be subject to penalties and interest. 1111 Constitution Ave. NW Washington, DC 20224 Do not send the form to this address. Instead, see Where to file on page 3.
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