Form 730 - Tax On Wagering (Section 4401 Of The Internal Revenue Code) - 1996
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1730
Tax on Wagering
Form
OMB No. 1545-0235
(Rev. November 1996)
(Section 4401 of the Internal Revenue Code)
Department of the Treasury
For Paperwork Reduction Act Notice, see page 2.
For IRS Use Only
Internal Revenue Service
T
Enter your
name,
FF
address,
Name
Month and year
FD
employer
identification
FP
number,
Employer identification number
Number, street, and room or suite no.
and
I
month and
T
year of
return.
City, state, and ZIP code
If address is different
from prior return,
check here
1
1
Gross wagers accepted during month (not including layoffs)
2
2
Gross amount of layoff wagers accepted during month
3
3
Add lines 1 and 2
4a
Tax on wagers authorized under the law of the state in which accepted
4a
(multiply the amount of these wagers included on line 3 by .0025)
b Tax on wagers, other than wagers described on line 4a (multiply the
4b
amount of these wagers included on line 3 by .02)
4c
c Add lines 4a and 4b
5
5
Layoff credits (No credit is allowed unless supported by evidence.)
6
Net tax due. (Subtract line 5 from line 4c.) If no tax is due, write “NONE”
6
File this return and your payment with the IRS as shown under Where To File on page 2. Make your check or money order payable
to the “Internal Revenue Service”. Write your name, address, EIN, and “Form 730” on it.
Under penalties of perjury, I declare that I have examined this return and any accompanying certificates and statements, and, to the best of my
knowledge and belief, they are true, correct, and complete.
Sign
Here
Keep a copy
Signature
of this return
for your records.
Title (Owner, etc.)
Date
730
Cat. No. 20585U
Form
(Rev. 11-96)
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