Original PDF Flash format form-2290-(rev.-july-2009)  


Form 2290 (rev. July 2009)

2290
Heavy Highway Vehicle Use Tax Return
Keep a copy of this
Form
For the period July 1, 2009, through June 30, 2010
return for your records.
(Rev. July 2009)
Department of the Treasury
Attach both copies of Schedule 1 to this return.
OMB No. 1545-0143
Internal Revenue Service (99)
See the separate instructions.
Name
Employer identification number
FOR IRS
USE ONLY
–
Address (number, street, and room or suite no.)
Type
T
or Print
FF
FP
City, state, and ZIP code (For Canadian or Mexican address, see page 5 of the instructions.)
I
T
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
vehicles exceeding the mileage use limit. Do not check
Final Return
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 2009? If YES,
enter 200907 in the boxes to the right. If NO, see the table on page 3 of the instructions .
1
2
Tax. Enter the Total from Form 2290, page 2, column (4) . . . . . . . . . . .
2
.
3
Additional tax from increase in taxable gross weight. See page 5 of the instructions . .
3
.
4
Total tax. Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . .
4
.
5
Credits. See page 5 of the instructions . . . . . . . . . . . . . . . . .
5
.
6
Balance due. Subtract line 5 from line 4. This is the amount you owe. If payment through
EFTPS, check here . . . . . . . . . . . . . . . . . . . . . .
6
.
Part II
Statement in Support of Suspension (Complete the statements that apply. Attach additional sheets if needed.)
7
I declare that the vehicles listed in Part II of Schedule 1 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, 2009, through June 30, 2010, and are suspended from the tax. Complete and attach Schedule 1.
8a I declare that the vehicles listed as suspended on the Form 2290 filed for the period July 1, 2008, through June 30, 2009, 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, 2008, through June 30, 2009. These vehicles were sold or
transferred to
on
,
.
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 Designee’s
Phone
Personal identification
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, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any
Sign
knowledge.
Here
Signature
Date
Type or print name below signature.
Telephone number
Paid
Preparer’s
Date
Check if
Preparer’s SSN or PTIN
self-
Preparer’s signature
employed
Firm’s name (or
Use Only
EIN
yours if self-employed),
address, and ZIP code
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see page 9 of the instructions.
Cat. No. 11250O
Form 2290 (Rev. 7-2009)
Form 2290 (Rev. 7-2009)
Page 2
Tax Computation
(1)
(2)
(3)
(4)
Annual tax
Partial-period tax
Number of
Amount of tax
(vehicles used
(vehicles first used after July)
vehicles
(col. (1) or (2)
during July)
(See the tables on page 10 of
times col. (3))
the instructions.)
(a)
(b)
(a)
(b)
(a)
(b)
Category
Vehicles
Logging
Vehicles
Logging
Vehicles
Logging
Category
Taxable Gross Weight
Except Logging*
Vehicles*
Except Logging*
Vehicles*
Except Logging*
Vehicles*
(in pounds)
A
55,000
$100.00
$75.00 $
$
$
A
B
55,001 – 56,000
122.00
91.50
B
C
56,001 – 57,000
144.00
108.00
C
D
57,001 – 58,000
166.00
124.50
D
E
58,001 – 59,000
188.00
141.00
E
F
59,001 – 60,000
210.00
157.50
F
G
60,001 – 61,000
232.00
174.00
G
H
61,001 – 62,000
254.00
190.50
H
I
62,001 – 63,000
276.00
207.00
I
J
63,001 – 64,000
298.00
223.50
J
K
64,001 – 65,000
320.00
240.00
K
L
65,001 – 66,000
342.00
256.50
L
M
66,001 – 67,000
364.00
273.00
M
N
67,001 – 68,000
386.00
289.50
N
O
68,001 – 69,000
408.00
306.00
O
P
69,001 – 70,000
430.00
322.50
P
Q
70,001 – 71,000
452.00
339.00
Q
R
71,001 – 72,000
474.00
355.50
R
S
72,001 – 73,000
496.00
372.00
S
T
73,001 – 74,000
518.00
388.50
T
U
74,001 – 75,000
540.00
405.00
U
V
Over 75,000
550.00
412.50
V
Totals. Add the number of vehicles in columns (3a) and (3b). Enter the total here
and on Schedule 1, Part III, line a. Add the amounts in column (4). Enter the total
here and on Form 2290, line 2
. . . . . . . . . . . . . . . . .
$
Tax-Suspended Vehicles
W (See Part II on page 6 of
the instructions.)
Complete both copies of Schedule 1 (Form 2290) and attach them to Form 2290.
* See page 2 of the instructions for information on logging vehicles.
Form 2290 (Rev. 7-2009)
SCHEDULE 1
Schedule of Heavy Highway Vehicles
(Form 2290)
For the period July 1, 2009, through June 30, 2010
(Rev. July 2009)
OMB No. 1545-0143
Department of the Treasury
Complete both copies of Schedule 1 and attach them to Form 2290.
Internal Revenue Service
See the Consent to Disclosure of Tax Information on page 2.
Name as shown on Form 2290
Employer identification number
FOR IRS
–
USE ONLY
Address (number, street, and room or suite no.)
Type
T
or Print
FF
FP
City, state, and ZIP code (For Canadian or Mexican address, see page 5 of the instructions.)
I
T
Caution. You must list all vehicles. Attach a separate list if needed. See page 7 of the instructions.
Part I
Vehicles on Which You Are Reporting Tax. Enter VIN and category.
Category
1
2
3
4
5
Part II
Vehicles for Which Tax Is Suspended—5,000 Miles or Less (7,500 Miles or Less for
Agricultural Vehicles). Enter VIN.
Category
1
W
2
W
Part III
Summary of Reported Vehicles
a Enter the number of taxable vehicles from Form 2290, page 2, column 3, Totals
. . . . . . . . . . .
a
b Enter the total number of taxable vehicles on which the tax is suspended from Form 2290, page 2, column 3 (category W)
b
For Privacy Act and Paperwork Reduction Act Notice, see page 9 of the instructions.
Schedule 1 (Form 2290) (Rev. 7-2009)
Do not cut or separate the forms on this page.
SCHEDULE 1
Schedule of Heavy Highway Vehicles
(Form 2290)
For the period July 1, 2009, through June 30, 2010
(Rev. July 2009)
OMB No. 1545-0143
Department of the Treasury
This copy will be stamped and returned to you for use as proof of payment when registering
Internal Revenue Service
vehicle(s) with a state.
Name as shown on Form 2290
Employer identification number
–
Address (number, street, and room or suite no.)
Type
or Print
City, state, and ZIP code (For Canadian or Mexican address, see page 5 of the instructions.)
Caution. You must list all vehicles. Attach a separate list if needed. See page 7 of the instructions.
Part I
Vehicles on Which You Are Reporting Tax. Enter VIN and category.
Category
1
2
3
4
5
Part II
Vehicles for Which Tax Is Suspended—5,000 Miles or Less (7,500 Miles or Less for
Agricultural Vehicles). Enter VIN.
Category
1
W
2
W
Part III
Summary of Reported Vehicles
a Enter the number of taxable vehicles from Form 2290, page 2, column 3, Totals
. . . . . . . . . . .
a
b Enter the total number of taxable vehicles on which the tax is suspended from Form 2290, page 2, column 3 (category W)
b
For Privacy Act and Paperwork Reduction Act Notice, see page 9 of the instructions.
Cat. No. 11250O
Schedule 1 (Form 2290) (Rev. 7-2009)
Schedule 1 (Form 2290) (Rev. 7-2009)
Page 2
Consent to Disclosure of Tax Information
For the period July 1, 2009, through June 30, 2010
By signing, dating, and entering my employer identification number below, I hereby consent to the
Internal Revenue Service (IRS) disclosing information about my payment of the Heavy Highway
Vehicle Use Tax (HVUT) for the tax period listed above to the federal Department of Transportation
(DOT), U.S. Customs and Border Protection (CBP), and to state Departments of Motor Vehicles
(DMV). The information disclosed to the DOT, CBP, and state DMVs will be my Vehicle Identification
Number (VIN) and verification that I have paid the HVUT. The IRS may disclose the information to the
DOT, CBP, and to the DMVs of the 50 states and the District of Columbia who have other taxing,
registration, or information collecting authority.
I understand that the information to be disclosed is generally confidential under the laws
applicable to the IRS and that the agency receiving the HVUT information is not bound by these laws
and may use the information for any purpose as permitted by other federal laws and/or state law. To
be effective, this consent must be submitted to the IRS within 60 days of the date below.
If signed by a corporate officer or party other than the taxpayer, I certify that I have the authority to
execute this consent to disclosure of tax information.
Sign
Here
Signature
Date
Type or print name below signature.
Employer identification number
Schedule 1 (Form 2290) (Rev. 7-2009)
Form 2290-V, Payment Voucher
Purpose of Form
Box 2. Enter the amount paid from line 6 of Form 2290.
Complete Form 2290-V if you are making a payment by
Box 3. Enter the date as shown on line 1 of Form 2290.
check or money order with Form 2290, Heavy Highway
Box 4. Enter your name and address as shown on Form
Vehicle Use Tax Return. We will use Form 2290-V to
2290.
credit your payment more promptly and accurately, and
to improve our service to you.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure to enter your EIN,
If you have your return prepared by a third party and a
“Form 2290,” and the tax period on your check or money
payment is required, provide Form 2290-V to the return
order. Do not send cash. Do not staple Form 2290-V or
preparer.
your payment to Form 2290 (or to each other).
Do not file Form 2290-V if you are paying the balance
● Detach Form 2290-V and send it with your payment and
due on line 6 of Form 2290 using EFTPS or electronic
Form 2290. See Where to file on page 3 of the
funds withdrawal (direct debit).
instructions for Form 2290.
Specific Instructions
Box 1. If you do not have an EIN, you may apply for one
online. Go to the IRS website at
www.irs.gov/businesses/small and click on the “Employer
ID Numbers (EIN)” link. You may also apply for an EIN by
calling 1-800-829-4933, or you can fax or mail Form
SS-4, Application for Employer Identification Number, to
the IRS.
Detach here
2290-V
Payment Voucher
Form
For the period July 1, 2009, through June 30, 2010
(Rev. July 2009)
OMB No. 1545-0143
See How To Make Your Payment on page 7 of the instructions.
Department of the Treasury
Internal Revenue Service
Do not staple or attach this voucher or your payment to your return.
1 Employer identification number
2
Dollars
Cents
Enter the amount of your payment.
3 Enter date as shown on line 1 of Form 2290.
4 Name
Y
Y
Y
Y
M
M
Address
Send Form 2290, this voucher, and payment to:
Internal Revenue Service
City, state, and ZIP code (For Canadian or Mexican address, see instructions.)
P.O. Box 804525
Cincinnati, OH 45280-4525