Form 9117 Excise Tax Program Order Blank for Forms and Publication

FILE: 10242g09_a01.g
PRINTED: Sat May 30 08:55:02 2009
CREATED: Sat May 30 08:55:02 2009

Page 45 of 48 of Form 720

(Pages 46 is blank)

1

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Excise Tax Program Order Blank
for Forms and Publications

9117

Form
(Rev. January 2009)

OMB No. 1545-1096

Visit the IRS website at www.irs.gov

Department of the Treasury
Internal Revenue Service

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For Paperwork Reduction Act Notice, see below.

Instructions

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Type or print your name and complete mail delivery address below. An accurate mail delivery address is necessary to ensure delivery
of your order. Enter the quantity next to the item you are ordering. If the form you are ordering is needed to file a prior year return,
you may obtain it by calling 1-800-829-3676.
TITLE

ITEM

QUANTITY

ITEM

F 11-C

Occupational Tax and
Registration Return for
Wagering

F 637

Application for Registration (For
Certain Excise Tax Activities)

F 720

Quarterly Federal Excise Tax
Return
Instructions for Form 720

F 8849

Amended Quarterly Federal
Excise Tax Return
Monthly Tax Return for Wagers

Sch 1
(F 8849)

I 720
F 720X
F 730
F 843

Heavy Highway Vehicle Use
Tax Return
Instructions for Form 2290

F 2290
I 2290

QUANTITY

F 2290(FR) Déclaration d’Impôt sur
l’Utilisation des Véhicules
Lourds sur les Routes
I 2290(FR) Instructions pour le Formulaire
2290(FR)
Gas Guzzler Tax
F 6197
Environmental Taxes
F 6627

Claim for Refund and Request
for Abatement
Instructions for Form 843

I 843

TITLE

F 2290(SP) Declaración del Impuesto sobre
el Uso de Vehículos Pesados en
las Carreteras
I 2290(SP) Instrucciones para el
Formulario 2290(SP)

Claim for Refund of Excise
Taxes
Nontaxable Use of Fuels

Sch 2
(F 8849)

Sales by Registered Ultimate
Vendors

Sch 3
(F 8849)
Sch 5
(F 8849)

Certain Fuel Mixtures and
the Alternative Fuel Credit
Section 4081(e) Claims

Sch 6
(F 8849)

Other Claims

Sch 8
(F 8849)

Registered Credit Card Issuers

Pub 509
Pub 510

Tax Calendars
Excise Taxes

Name

Print
or
Type

Number and Street

Apt./Suite/Room

State

City

Foreign Country

(

ZIP Code

International Postal Code

)

Daytime Telephone Number

Where To Send Your Order
Send your order to the address below.
Internal Revenue Service
1201 North Mitsubishi Motorway
Bloomington, IL 61705-6613
Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. Your response is voluntary.
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 Code section 6103.
The time needed to complete this form will vary
depending on the individual circumstances. The estimated
average time is 2 minutes. If you have comments
concerning the accuracy of this time estimate 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 Form 9117 to this address. Instead, send
your order to the address listed under Where To Send
Your Order.