Form  6627                                         Environmental Taxes 
                                                                                                                                 OMB No. 1545-0023
(Rev. January 2023)                                    Attach to Form 720.
Department of the Treasury  
Internal Revenue Service       Go to www.irs.gov/Form6627 for instructions and the latest information.
Name (as shown on Form 720)                                                       Quarter ending                    Employer identification number (EIN) 

                                                                                                     (a)                (b)          (c) 
Part I      Tax on Petroleum                                                                       Barrels          Rate             Tax
   1  Crude oil received at a U.S. refinery  .   . . . .     . .      . .  . .  .    
   2  Crude oil taxed before receipt at refinery   . . .     . .      . .  . .  .
   3  Taxable  crude  oil.  Subtract  line  2  from  line  1.  Enter  the  result  on  both 
      lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by 
      multiplying column (a) by column (b) for both lines.                                 (a)             $ .164 bbl $
                                                                                  (b)                      $ .09 bbl $
   4  Crude oil used in or exported from the U.S. before the tax was imposed. 
      Multiply column (a) by column (b) and enter the amount of tax in column 
      (c). Enter on both lines 4(a) and 4(b), column (a). Enter in column (c) the 
      amount of tax by multiplying column (a) by column (b) for both lines.     (a)                        $ .164 bbl $
                                                                                  (b)                      $ .09 bbl $
   5  Total domestic petroleum superfund tax (add lines 3(a) and 4(a), column 
      (c)). Enter here and on Form 720 on the line for IRS No. 53   .      . .  .                                               $
   6  Total domestic petroleum oil spill tax. Add lines 3(b) and 4(b), column (c). 
      Enter the total here and on Form 720 on the line for IRS No. 18  .     .  .                                               $
   7  Imported petroleum products superfund tax. Enter the number of barrels 
      imported  in  column  (a).  (Must  agree  with  line  8,  column  (a).)  Enter  in 
      column (c) the amount of tax by multiplying column (a) by column (b), and 
      also enter it on Form 720 on the line for IRS No. 16  .  .      . .  . .  .                          $ .164 bbl $
   8  Imported  petroleum  products  oil  spill  tax.  Enter  the  number  of  barrels 
      imported  in  column  (a).  (Must  agree  with  line  7,  column  (a).)  Multiply 
      column (a) by column (b) and enter the amount of tax in column (c). Also 
      enter the amount on Form 720 on the line for IRS No. 21  .        .  . .  .                          $ .09 bbl $
Part II     Tax on Chemicals (Other Than Ozone-Depleting Chemicals (ODCs)), IRS No. 54
        Chemical                                     (c) Tax                    Chemical                                             (c) Tax 
      (general formula         (a) Tons (b) Rate (multiply column (a)        (general formula              (a) Tons     (b) Rate  (multiply column (a) 
        or symbol)                                 by column (b))               or symbol)                                           by column (b))
1  Acetylene (C2H2)                     $9.74                           24 Lead oxide (PbO)                             $8.28
2  Ammonia (NH3)  .                     5.28                            25 Mercury (Hg)  .         .                        8.90
3  Antimony (Sb)  .                     8.90                            26 Methane (CH4)  .                                 6.88
4  Antimony trioxide                                                    27 Naphthalene (C10H8)                              9.74
   (Sb2O3)   .      .    .              7.50                            28 Nickel (Ni)  .        . .                        8.90
5  Arsenic (As)  .       .              8.90                            29 Nitric acid (HNO3)                               0.48
6  Arsenic trioxide                                                     30 Phosphorus (P)  .                                8.90
   (As2O3) . .      .    .              6.82                            31 Potassium 
7  Barium sulfide (BaS)                 4.60                               dichromate (K2        Cr2 7O )                   3.38
8  Benzene (C6H6)  .                    9.74                            32 Potassium 
9  Bromine (Br)  .       .              8.90                               hydroxide (KOH) .                                0.44
10 Butadiene (C4H6)                     9.74                            33 Propylene (C3H6) .                               9.74
11 Butane (C4H10)  .                    9.74                            34 Sodium dichromate 
12 Butylene (C4H8)  .                   9.74                               (NaCr2O7)  .          . .                        3.74
13 Cadmium (Cd)  .                      8.90                            35 Sodium hydroxide 
14 Chlorine (Cl)  .      .              5.40                               (NaOH)  .           . . .                        0.56
15 Chromite (FeCr2O4)                   3.04                            36 Stannic chloride 
16 Chromium (Cr)  .                     8.90                               (SnCl4)  .          . . .                        4.24
17 Cobalt (Co)  .        .              8.90                            37 Stannous chloride 
18 Cupric oxide (CuO)                   7.18                               (SnCl2)  .          . . .                        5.70
19 Cupric sulfate (CuSO4    )           3.74                            38 Sulfuric acid (H2       SO4 )                    0.52
20 Cuprous oxide (Cu2       O)          7.94                            39 Toluene (C7H8)  .                                9.74
21 Ethylene (C2H4)  .                   9.74                            40 Xylene (C8H10)          .                        9.74
22 Hydrochloric acid (HCI)              0.58                            41 Zinc chloride (ZnCl2       )                     4.44
23 Hydrogen fluoride (HF)               8.46                            42 Zinc sulfate (ZnSO4        )                     3.80
43    Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line for IRS No. 54                     $
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 720.                  Cat. No. 43490I         Form 6627 (Rev. 1-2023) 

Form 6627 (Rev. 1-2023)                                                                                                                 Page 2
Part III   Tax on Imported Chemical Substances, IRS No. 17
                                                       (c) Taxable chemical  
           (a) Imported chemical       (b) Tons      used in manufacture       (d) Conversion factor or   (e) Rate             (f) Tax  
           substance                                     of substance              entry value                            (see instructions) 

1

2

3
4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any
  additional sheets. Enter here and on Form 720 on the line for IRS No. 17  .      .     . . . . .      . . .        $ 
Part IV    Tax on Ozone-Depleting Chemicals (ODCs), IRS No. 98 
Elections. If you elect to report the tax on post-1989 ODCs at the time you sell or use a mixture containing such chemicals 
instead of when you make the mixture, check this box (the 1990 election) .     . . .     . . . . .      . . .    .      . .  . . .       
If you elect to report the tax on post-1990 ODCs at the time you sell or use a mixture containing such chemicals instead of when 
you make the mixture, check this box (the 1991 election)   . .  .   .   .    . . . .     . . . . .      . . .    .      . .  . . .
                                     (a) ODC                                   (b) Number      (c) Tax per pound               (d) Tax  
                                                                               of pounds     (see Part IV instructions)   (multiply column (b) 
                                                                                                                            by column (c)) 

1

2

3
4 Total  ozone-depleting  chemicals  tax.         Add  all  amounts  in  column  (d).  Include  amounts  from  any
  additional sheets. Enter the total here and on Form 720 on the line for IRS No. 98       . . . .      . . .           $ 
Part V     ODC Tax on Imported Products, IRS No. 19 
Election. If you elect to report the tax on imported products at the time you import the products instead of when you sell or use 
the products, check this box .   .   . . .   .  . .  . .   . .  .   .   .    . . . .     . . . . .      . . .    .      . .  . . .
           (a) Imported product and      (b) Number    (c) ODC weight          (d) Tax         (e) Entry value                 (f) Tax 
           the applicable ODC            of products     of product            per pound                                (see Part V instructions)

1

2

3
4 Total  ODC  tax  on  imported  products.        Add  all  amounts  in  column  (f).  Include  amounts  from  any
  additional sheets. Enter the total here and on Form 720 on the line for IRS No. 19       . . . .      . . .           $ 
Part VI    Tax on Floor Stocks of ODCs, IRS No. 20 
                                     (a) ODC                                   (b) Number      (c) Tax per pound               (d) Tax  
                                                                               of pounds     (see Part VI instructions)   (multiply column (b) 
                                                                                                                            by column (c)) 

1

2

3
4 Total floor stocks tax.        Add all amounts in column (d). Include amounts from any additional sheets. 
  Enter the total here and on Form 720 on the line for IRS No. 20       .    . . . .     . . . . .      . . .           $ 
                                                                                                                        Form 6627 (Rev. 1-2023)