11-C (Draft 2012) Occupational Tax and Registration Return for Wagering

Changes shown in yellow.

Deletions shown in blue.

December 2012

11-C

Occupational Tax and Registration Return for Wagering

Form
(Rev. April 2008)

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0236

Return for period from

,
(Month and day)

to June 30,
(Year)

(Year)

Name

Type
or
Print

Employer identification number

Number, street, and room or suite no.

City, state, and ZIP code

Check one:

First return
Renewal return
Supplemental registration (Do not complete lines 1, 2, 4, 5, and 6.)

Daytime telephone number

(

)

Business address (if different from your home address or address entered above)

For IRS Use Only

Alias, style, or trade name, if any

Part I

Occupational Tax

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:

Part II
4

Principal

$

Agent accepting wagers for another (see instructions)

Additional Information (for principal only)

If the taxpayer is a firm, partnership, or corporation, give the true name of each member or officer.
True name

5

1
2
3
4
5

T $
FF
FP
I
T $

Title

Home address

Social security number

Are you or will you be engaged in the business of accepting wagers on your own account?
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)

Yes

No

City, state, and ZIP code

b Number of agents engaged in receiving wagers on your behalf 䊳
c True name, address, and employer identification number of each agent:
True name

Address

Employer identification number

12-2012
For Privacy Act and Paperwork Reduction Act Notice, see page 6.

Cat. No. 16166V

Form

11-C

(Rev. 4-2008)

12-2012
Page

Form 11-C (Rev. 4-2008)

Part III
6

2

Additional Information (for agents accepting wagers on behalf of others)

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.

Sign
Here

Under penalties of perjury, I declare that I have examined this return and/or registration (including any accompanying statements or lists), and, 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 knowledge.

䊳

Paid
Preparer’s
Use Only

Signature

䊳

Date

䊳

Preparer’s
signature
Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

䊳

Title
Check
if selfemployed

Preparer’s SSN or PTIN

EIN
Phone no. (
Form

12-2012

)

11-C

(Rev. 4-2008)

Put "Section
references..."
sentence first.
Then "What's New"
paragraph.
Then "General
Instructions"
What's New
The IRS has created
a page on IRS.gov
for information about
Form 11-C and its
instructions, at www.
irs.gov/form730.
Information about
any future
developments
affecting Form 11-C
(such as legislation
enacted after we
release it) will be
posted on that page.

12-2012
Page

Form 11-C (Rev. 4-2008)

General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.
Purpose of form. Form 11-C is used to register
certain information with the IRS and to pay the
occupational tax on wagering. You must pay the
occupational tax if you accept taxable wagers for
yourself or another person. There are two amounts of
occupational tax ($50 or $500). One or the other
applies depending on whether the wagers you accept
are authorized by the laws of the state in which you
accept the wager. See the instructions for Line 2 to
determine your occupational tax. Your cancelled check
is proof of registration and payment.
Who must file. File Form 11-C if you are a principal or
an agent.
1. A principal is a person who is in the business of
accepting taxable wagers for his or her own account.
This is the person who makes a profit or risks loss
depending on the outcome of the event or contest for
which the wager is accepted.
2. An agent is a person who accepts taxable wagers
on the principal’s behalf.
Taxable wagers include those placed:
● On a sports event or contest with a person engaged
in the business of accepting wagers on a sports event
or contest.
● In a wagering pool on a sports event or contest if the
pool is conducted for profit.
● In a lottery conducted for profit (other than a
state-conducted lottery). The term lottery includes the
numbers game, policy, punch boards, and similar
types of wagering.
What is not taxed. The tax is not imposed on the
following five items.
● A parimutuel wagering enterprise, including horse
racing, dog racing, and jai alai, when licensed under
the laws of the state in which accepted.
● Coin-operated devices, such as pinball machines.

3

When to file. File the first return before wagers are
accepted. After that, file a renewal return by July 1 for
each year wagers are accepted. A first return is also
due in certain situations in which there has been a
change in ownership or control. The return must be
filed within 30 days after new members are admitted to
a firm or partnership; a corporation is formed to
continue the business of a partnership; or a
stockholder continues the business of a dissolved
corporation.
Employer Identification Number (EIN). Enter your
EIN. If you do not have an EIN, apply for one online.
Go to the IRS website at www.irs.gov/businesses/small
and click on the “Employer ID Numbers” 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.
Address. If you are an individual, enter your home
address.
Signature. Form 11-C must be signed by a person
who has authority to sign for the taxpayer.
Where to file. Mail Form 11-C, your check or money
order, and Form 11-C(V) to:
Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0101
Mail the return using the U.S. Postal Service or other
designated private delivery service. See the
instructions for your income tax return for more
information about private delivery services.
Penalties. There are penalties 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.

If you receive a
notice about penalty
and interest after you
file this return, send
us an explanation
and we will
determine if you
Disclosure of information on wagering taxes. Except meet reasonablefor administering or enforcing Internal Revenue taxes,
cause criteria. Do not
neither the Treasury Department nor any of its
attach an explanation
employees may disclose documents, records, or
when you file your
information obtained through them that a taxpayer
supplies in connection with wagering taxes. Also,
return.

● Sweepstakes, wagering pools, or lotteries that are
conducted by an agency of a state, if the wager is
placed with the state agency or its authorized agents
or employees.
● Games of the type in which usually all persons
placing wagers in the game are present when wagers
are placed, winners are determined, and prizes or
other property are distributed.

certain documents related to wagering taxes and
information obtained through them that relates to
wagering taxes may not be used against the taxpayer
in any nontax criminal proceeding. See section 4424
for more details.
Refund. A refund for an overpayment of the
occupational tax may be claimed on Form 8849, Claim
for Refund of Excise Taxes, using Schedule 6. See the
Instructions for Form 8849 for details.

● Drawings conducted by an organization exempt from
tax under sections 501 or 521, as long as the net
proceeds of the drawing do not inure to the benefit of
a private shareholder or individual.

Specific Instructions

Definitions. See the Instructions for Form 730 for the
definition of sports event, contest, wagering pool, and
lottery.

Return period. Enter the month, day, and year the
return period begins. Also, enter the ending year. Write
the year as a four-digit number (for example, 2008 or
2009).

2012
2013

12-2012
Page

Form 11-C (Rev. 4-2008)

Line 1. Enter the day and month that you will start
accepting wagers. A full month’s tax is due regardless
of which day you start accepting wagers during a
month.
Line 2. Use the table below to determine the tax. The
$50 tax applies if all wagers (including those accepted
by an agent for another) are authorized under the laws
of the state in which accepted. If you intend to accept
wagers that are not authorized by the state, the $500
tax applies. The tax is payable for the period that
begins July 1 of each year. If you start accepting
wagers after July 31, the tax is prorated for the first
year.
Note. This tax is paid once for each period that begins
July 1. If you are required to file a supplemental
registration, do not pay the tax a second time.
If you start
accepting
wagers in
July
August
September
October
November
December
January
February
March
April
May
June

$500
tax

$50
tax

$500.00
458.33
416.66
375.00
333.33
291.66
250.00
208.33
166.66
125.00
83.33
41.66

$50.00
45.83
41.66
37.50
33.33
29.16
25.00
20.83
16.66
12.50
8.33
4.16

Payment voucher. Complete Form 11-C(V), Payment
Voucher, and file it with Form 11-C and your payment.
Line 3. You must check one of the boxes. See Who
must file for the definition of principal and agent.
Principals are liable for the excise tax on wagers,
which is reported and filed monthly on Form 730,
Monthly Tax Return for Wagers.
Lines 4 and 5. These lines are to be completed by
principals only. Enter applicable information for officers
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.

4

Line 6. This line is to be completed by agents
accepting wagers on behalf of another. Enter the
name, address, and EIN of each person or company
on whose behalf you accept wagers.

Supplemental Registration
Line 7. A supplemental registration must be filed by
principals within 30 days (except for items 1 and 7
below) when any of the following events occur.
1. You change your business or home address. You
must register the change before accepting wagers at
the new address or by the end of the 30-day period
after the change of address, whichever occurs first.
2. You continue for the remainder of the period, as
the surviving spouse or child, executor, administrator,
or other legal representative, the business of a
deceased person who paid the occupational tax.
3. You continue for the remainder of the period the
business as a receiver or trustee in bankruptcy.
4. You continue for the remainder of the period the
business as an assignee for creditors.
5. One or more members withdraws from a firm or
partnership.
6. The corporate name is changed.
7. You engage a new agent to receive wagers. You
must file a supplemental registration to report the
name, address, and EIN of each new agent within 10
days after you engage the agent.
Agents. You must complete line 7 if you have
previously filed Form 11-C and are engaged to receive
wagers for another. You must register the name,
address, and EIN of each new person who engaged
you within 10 days after being engaged.
How to file a supplemental registration. Complete
the name, address, EIN, business address, and alias
lines. Also, be sure to check the “supplemental
registration” box. Then check the applicable box on
line 3 and enter the information that has changed on
line 7, including the date of the event of change. Do
not complete lines 1, 2, 4, 5, or 6 for a supplemental
registration.

Form 11-C(V),
Payment Voucher
Purpose of Form
Complete Form 11-C(V), Payment Voucher, and file it
with Form 11-C, Occupational Tax and Registration
Return for Wagering. We will use Form 11-C(V) to
credit your payment more promptly and accurately,
and to improve our service to you.
If you have your return prepared by a third party,
provide Form 11-C(V) to the return preparer.

Specific Instructions
Box 1. If you do not have an EIN, apply for one online.
Go to the IRS website at www.irs.gov/businesses/small
and click on the “Employer ID Numbers” 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.

12-2012

Form

䊲

Box 2. Enter the amount paid with Form 11-C.
Box 3. Enter the same year and month you entered on
the “Return for period from” line at the top of Form
11-C. For example, if your return is for the full period
that begins July 1, 2008, enter 200807.
Box 4. Enter your name and address as shown on
Form 11-C.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure to enter your
EIN, “Form 11-C,” and the tax period on your check or
money order. Do not send cash. Do not staple
Form 11-C(V) or your payment to Form 11-C (or to
each other).
● Detach Form 11-C(V) and send it with your payment
and Form 11-C. See Where to file on page 3.

Detach Here and Mail With Your Payment and Form 11-C.

11-C(V)

䊲

Payment Voucher

(Rev. April 2008)

OMB No. 1545-0235

Department of the Treasury
Internal Revenue Service

䊳

Do not staple or attach this voucher to your payment or Form 11-C.

1 Enter your employer identification
number.

3

Enter the amount of your payment.

Y

Y

Y

M

M
Enter your address.

Send Form 11-C, this voucher, and payment to:
Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0101

䊳

4 Enter your business name (individual name if sole proprietor).

Enter year and month as shown on Form 11-C.

Y

Dollars

2

Enter your city, state, and ZIP code.

Cents

2012
201207

12-2012
Page

Form 11-C (Rev. 4-2008)

Privacy Act and Paperwork
Reduction Act Notice
We ask for the information on Form 11-C to carry out
the Internal Revenue laws of the United States. You
are required to give us the information. We need it to
ensure that you are complying with these laws and to
allow us to figure and collect the right amount of tax.
Section 4411 imposes a special tax on each person
who is engaged in receiving wagers for or on behalf of
any person liable for the tax on wagers. Section 4412
requires that person to register with the IRS. Form
11-C is used to determine the amount of the tax you
owe and to register certain information with the IRS.
Section 6109 requires you to provide your identification
number. Unless specifically prohibited by law, routine
uses of this information include giving it to the
Department of Justice for civil and criminal litigation; to
cities, states, and the District of Columbia for use in
administering their tax laws; to other countries under a
tax treaty; to federal and state agencies to enforce
federal nontax criminal laws; or to federal law
enforcement and intelligence agencies to combat
terrorism. If you fail to provide this information in a
timely manner, you may be subject to penalties and
interest.

SE:W:CAR:MP:T:M:S

6

You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or
its instructions must be retained as long as their
contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by
section 6103.
The time needed to complete and file this form will
vary depending on individual circumstances. The
estimated average time is: Recordkeeping, 7 hr., 24
min.; Learning about the law or the form, 57 min.;
Preparing the form, 2 hr., 3 min.; and Copying,
assembling, and sending the form to the IRS, 16
min.

:

If you have comments concerning the accuracy of
these time estimates or suggestions for making this
form simpler, we would be happy to hear from you.
You can write to the Internal Revenue Service, Tax
Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send the form
to this address. Instead, see Where to file on page 3.

Indent and set out
the highlighted
address. No period
at the end.