om 11-€ Stamp Tax and Registration Return for Wagering (1989)

om 11-€ Stamp Tax and Registration Return for Wagering

(Rev. Novernber 1989)

OMB No. 1545-0236

Department of the Treasury Return for period from __.......__-.--.------ ,19 ____- toJune 30,19 ____. Expires: 10-31-92

Internal Revenue Service (Month, day, and year)

Name Social security number

v Otherwise Number and street

Please print or Employer identification number

City, state, and ZIP code (See instructions.)

Check one: |] First return L] Renewal return For IRS Use Only

L.] Supplemental registration return (Do not complete Part I.) Stam

Business address sumber >

Date rrr tre

issued >

T$ Ld: 1.

FF.

Alias, style, or trade name, if any FP 3

| 4 ieee

Part 1 | Stamp Tax (For first and renewal returns only) T $ 5

1 Enter month you will start accepting wagers during the tax period toe

2 Tax(Seeinstructions.) . . $

Make your check or money order payable to the Internal Revenue Service for the tax due and remit with the return.

Supplemental Registration Return (See instructions.)

1 Enter tax stamp number

2 Enter reason for supplemental registration return (See instructions. )

| Part HI | Additional Information (To be completed by all filers) (/f more space is needed, attach additional sheets identifying each line number.)

1 If taxpayer ts a firm, partnership, or corporation, give true name of members or officers.

True name Title Home address Social security number

2 Are you or will you be engaged in the business of accepting wagers on yourownaccount?.. . . . . . . 1... [] Yes LJ No

If ‘‘Yes,’’ complete (a), (b), and (c).

(a) Name and address where each such business is or will be conducted:

Name of location Address (number and street) City, state, and ZIP code

(c) True name, stamp tax number, address, and social security number of each such person:

True name Stamp tax number Address Social security number

3 Doyou receive or will you be receiving wagers on behalf of or as agent for some other person orpersons?. . . . . . LJ Yes LI] No

If ‘‘Yes,’’ give true name, address, and social security number of each such person.

True name Address Social security number

wlaait'a Signature

Under penalties of perjury, | declare that | have examined this return and/or registration (including any accompanying statements or lists), and, to the best of my knowledge

and belief, itis true, correct, and complete.

Signature > Title (Owner, etc.) > Date >»

For Paperwork Reduction Act Notice, see back of form. Form 11-C (Rev. 11-89)

Form 11-C (Rev. 11-89)

Page 2

Paperwork Reduction Act Notice.—We

ask for this information to carry out the

Internal Revenue laws of the United States.

We need it to ensure that taxpayers are

complying with these laws and to allow us to

figure and collect the right amount of tax.

You are required to give us this information.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time

is:

Recordkeeping . 7 hrs., 10 min.

Learning about the

law or the form . . 2hrs., 2 min.

Preparing the form . 4hrs., 5 min.

Copying, assembling,

and sending the form

to IRS . . . 32 min.

if you have comments concerning the

accuracy of these time estimates or

suggestions for making this form more

simple, we would be happy to hear from

you. You can write to the Internal Revenue

Service, Washington, DC 20224, Attention:

IRS Reports Clearance Officer, T:FP; or the

Office of Management and Budget,

Paperwork Reduction Project (1545-0236),

Washington, DC 20503.

General Instructions

(Section references are to the Internal

Revenue Cade, unless otherwise noted.)

Purpose of Form.—Form 11-C is used to

register to do business accepting wagers

and to pay the stamp tax on wagering. After

you file the form and pay the tax, you will be

issued a tax stamp as proof of registration

and payment. The tax is an annual tax that

applies in addition to the excise tax on

wagers. The excise tax on wagers is

reported on Form 730, Tax on Wagering.

Who Must File. —You must file Form 11-C

if you are in the business of accepting

wagers yourself or if you receive wagers for

someone else who |s in the business. For

this purpose, the term “wager” includes

those made:

(1) On sports events or contests with a

person in the business of accepting wagers.

(2) In a wagering pool on a sports event or

contest if the pool is run for profit.

(3) In a lottery run for profit. This includes

the numbers game, policy, punchboards,

and similar types of wagering. It does not

include a game where the wagers are

placed, winners are picked, and prizes are

given out in front of everyone who placed a

wager in the game. Also it does not include

a drawing run by a tax-exempt organization

if none of the profits go to a private

shareholder or individual.

When To File. —File your first return before

you begin accepting wagers. After that, file

a renewal return by July 1 for each year you

accept wagers. You should also file another

return when certain changes in ownership

occur and a supplemental registration

return when certain other changes occur.

Changes in ownership.—File another

return and pay the stamp tax within 30 days

after the day you admit new members to a

firm or partnership, you form a corporation

to continue the business of a partnership, or

you continue the business of a dissolved

corporation of which you were a

stockholder. Check the first return box on

Form 11-C because this Is the first return

for the new ownership.

Other changes.—Although you will not

owe more tax, you must file a supplemental

registration return within 30 days after any

of the following occurs:

(1) You change your business or home

address.

(2) You continue, as the surviving spouse

or child, executor, administrator, or other

legal representative, the business of a

deceased person who paid the stamp tax.

(3) You continue the business as a

receiver or trustee in bankruptcy.

(4) You continue the business as an

assignee for creditors.

(5) One or more members withdraws

from the firm or partnership.

(6) The corporate name is changed.

Attach your tax stamp to the return for

proper notation when filing such

supplemental registration return.

If you hire a new agent or employee to

receive wagers, you must file a

supplemental registration return to record

the name, stamp tax number, address, and

social security number of each new agent or

employee. See Part Ill, line 2(b) and (c) on

Form 11-C. Likewise, if you are hired to

receive wagers for another, you must

register the name, address, and social

security number of each new person by

whom you are hired. See Part Ill, line 3 on

Form 11-C. In either case, you must file the

return within 10 days after such hiring

occurs.

Figuring the Tax.—The tax is $500 per

year or $50 per year if all wagers are

authorized under the law of the state in

which accepted. The tax is figured from July

1 of each year, or from the first day of the

month in which you began business, to the

next June 30. If you began business during

July, the tax is $500. If you began business

after July, figure the tax by multiplying the

monthly rate of $41.66%4 by the number of

months left in the tax period.

Example.—lf you began business in

November, figure the tax as follows:

$4 1.66% x 8 (the number of months left in

the tax period) equals $333.33. Enter the

tax in Part I, line 2 on the return. If the

wagers are authorized under state law, the

tax is 10% of $333.33 = $33.33 because

the annual tax of $50 is 10% of $500.

Employer Identification Number.—If you

are required to file Form 11-C but do not

have an employer identification number,

complete Form SS-4, Application for

Employer Identification Number, and attach

it to your return when you file. If you have

applied for a number but have not yet

received it, write “applied for” in the block

on Form 11-C for the employer

identification number.

Where To File.—File your return with the

Internal Revenue Service Center, Ogden,

UT 84201.

Hand-carried returns.—You may file your

return by hand carrying it to your district

director or to any post of duty within your

Internal Revenue district.

Penalties.—There are penaities for not

filing on time, for accepting wagers before

paying the tax, and for willfully failing to file

the return. There are also penalties for

making or helping to make false returns,

documents, or statements.

Confidentiality of Information.—No

Treasury Department employee may

disclose information you supply in relation

to wagering tax except when needed to

administer or enforce the taxes. See section

4424 for more information.

U.S. Government Printing Office: 1989-261-151/00025