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Occupational Tax and Registration Return for Wagering
Form 11-C ▶ Go to www.irs.gov/Form11C for the latest information . OMB No. 1545-0236
(Rev. December 2017)
Department of the Treasury Return for period from , to June 30,
Internal Revenue Service (Month and day) (Year) (Year)
Name Employer identification number
Type
Number, street, and room or suite no.
or
Print
City or town, state or province, country, and ZIP or foreign postal code

Check one: First return Renewal return Daytime telephone number
Supplemental registration (Don’t complete lines 1, 2, 4, 5, or 6.)
Business address (if different from your home address or address entered above) For IRS Use Only

T $ 1
FF 2
Alias, style, or trade name, if any FP 3
I 4
Part I Occupational Tax T $ 5

1 Enter the date (month and day) you’ll start accepting wagers during the tax period . . . .

2 Tax (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . $
See the attached Form 11-C(V), Payment Voucher, for how to make your payments.

3 Check one: Principal Agent accepting wagers for another (see instructions)
Part II Additional Information (for principal only)
4 If the taxpayer is a firm, partnership, or corporation, give the true name of each member or officer.
True name Title Home address Social security number

5 Are you or will you be engaged in the business of accepting wagers on your own account? . . . . . Yes No
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) City or town, state or province, country, and ZIP or foreign postal code

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

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 16166V Form 11-C (Rev. 12-2017)

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Form 11-C (Rev. 12-2017)                                                                                          Page  2 
Part III Additional Information (for agents accepting wagers on behalf of others) 
6    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’re filing a supplemental registration. Include the date of the event. 

         Under penalties of perjury, I declare that I’ve examined this return and/or registration (including any accompanying statements or lists), and to the best of my 
         knowledge and belief, it’s true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any 
Sign     knowledge.
Here     ▲                                                       ▲
           Signature of officer                       Date               Title
         Print/Type preparer’s name Preparer’s signature                      Date                          PTIN
Paid                                                                                       Check         if 
                                                                                           self-employed
Preparer                  ▶                                                                Firm’s EIN  ▶
         Firm’s name      
         Firm’s address  
Use Only                 ▶                                                                 Phone no.
                                                                                                       Form  11-C  (Rev. 12-2017)

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Form 11-C (Rev. 12-2017)                                                                                               Page  3 
Section references are to the Internal Revenue Code       Definitions. See the Instructions for Form 730, Monthly 
unless otherwise noted.                                   Tax Return for Wagers, for the definition of sports event, 
                                                          contest, wagering pool, and lottery. 
Future Developments 
                                                          When to file. File the first return before wagers are  
For the latest information about developments related to  accepted. After that, file a renewal return by July 1 for  
Form 11-C and its instructions, such as legislation       each year wagers are accepted. A first return also is due 
enacted after they were published, go to www.irs.gov/     in certain situations in which there has been a change in 
Form11C.                                                  ownership or control. The return must be filed within 30 
What’s New                                                days after new members are admitted to a firm or 
Effective January 2018, send Form 11-C and/or Form        partnership, a corporation is formed to continue the 
11-C(V), Payment Voucher, to Ogden UT. See Where to       business of a partnership, or a stockholder continues the 
file, later, for the updated address.                     business of a dissolved corporation. 
                                                          Employer Identification Number (EIN). Enter your EIN. If 
General Instructions                                      you don’t have an EIN, apply for one online. Go to the IRS 
Purpose of form. Form 11-C is used to register certain    website at www.irs.gov/EIN. You also may apply for an 
information with the IRS and to pay the occupational tax  EIN by faxing or mailing Form SS-4, Application for 
on wagering. You must pay the occupational tax if you     Employer Identification Number, to the IRS.
accept taxable wagers for yourself or another person.     Address. If you’re an individual, enter your home  
There are two amounts of occupational tax ($50 or $500).  address. 
One or the other applies depending on whether the         Signature. Form 11-C must be signed by a person who 
wagers you accept are authorized by the laws of the state has authority to sign for the taxpayer. 
in which you accept the wager. See Line 2 later to        Where to file.Send Form 11-C, your check or money 
determine your occupational tax. Your cancelled check is  order, and Form 11-C(V) to: 
proof of registration and payment. 
                                                          Department of the Treasury                                   
Who must file.File Form 11-C if you’re a principal or an  Internal Revenue Service                                                  
agent.                                                    Ogden, UT 84201-0101
1. A principal is a person who is in the business of      Send the return using the U.S. Postal Service or other  
accepting taxable wagers for his or her own account.      designated private delivery service. See the instructions 
This is the person who makes a profit or risks loss       for your income tax return for more information about 
depending on the outcome of the event or contest for      private delivery services. 
which the wager is accepted. 
                                                          Penalties. There are penalties for not filing on time, for  
2. An agent is a person who accepts taxable wagers        accepting wagers before paying the tax, and for willfully 
on the principal’s behalf.                                failing to file the return. There also are penalties for 
Taxable wagers include those placed:                      making, or helping to make, false returns, documents, or 
• On a sports event or contest with a person engaged in   statements. 
the business of accepting wagers on a sports event or     If you receive a notice about a penalty after you file this 
contest.                                                  return, reply to the notice with an explanation and we will 
• In a wagering pool on a sports event or contest if the  determine if you meet reasonable-cause criteria. Don’t 
pool is conducted for profit.                             attach an explanation when you file your return.
• In a lottery conducted for profit (other than a state-  Disclosure of information on wagering taxes. Except  
conducted lottery). The term lottery includes the numbers for administering or enforcing Internal Revenue taxes,  
game, policy, punch boards, and similar types of          neither the Treasury Department nor any of its  
wagering.                                                 employees may disclose documents, records, or  
What isn’t taxed. The tax isn’t imposed on the following  information obtained through them that a taxpayer  
five items.                                               supplies in connection with wagering taxes. Also, certain 
• A parimutuel wagering enterprise, including horse       documents related to wagering taxes and information 
racing, dog racing, and jai alai, when licensed under the obtained through them that relates to wagering taxes 
laws of the state in which accepted.                      won’t be used against the taxpayer in any nontax criminal 
                                                          proceeding. See section 4424 for more details. 
• Coin-operated devices, such as pinball machines.
                                                          Refund. A refund for an overpayment of the occupational 
• Sweepstakes, wagering pools, or lotteries that are  
                                                          tax may be claimed on Form 8849, Claim for Refund of 
conducted by an agency of a state, if the wager is placed 
                                                          Excise Taxes, using Schedule 6 (Form 8849), Other 
with the state agency or its authorized agents or 
                                                          Claims. See the Instructions for Form 8849 for details. 
employees.
• Games of the type in which usually all persons placing 
wagers in the game are present when wagers are placed,    Specific Instructions 
winners are determined, and prizes or other property are  Return period. Enter the month, day, and year the return 
distributed.                                              period begins. Also, enter the ending year. Write the year 
• Drawings conducted by an organization exempt from       as a four-digit number (for example, 2017 or 2018). 
tax under sections 501 or 521, as long as the net  
proceeds of the drawing don’t inure to the benefit of a 
private shareholder or individual.

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Form 11-C (Rev. 12-2017) Page 4

Line 1. Enter the day and month that you will start Supplemental Registration
accepting wagers. A full month’s tax is due regardless of Line 7. If you, as a principal, change your home or
which day you start accepting wagers during a month. business address, you must file a supplemental
Line 2. Use the table below to determine the tax. The registration before accepting wagers at the new address
$50 tax applies if all wagers (including those accepted by or by the end of the 30-day period after the change,
an agent for another) are authorized under the laws of the whichever occurs first. If you engage a new agent to
state in which accepted. If you intend to accept wagers receive wagers, you must file, within 10 days of engaging
that aren’t authorized by the state, the $500 tax applies. the agent, a supplemental registration reporting the
The tax is payable for the period that begins July 1 of agent’s name, address, and EIN.
each year. If you start accepting wagers after July 31, the You must file a supplemental registration within 30
tax is prorated for the first year. days of the occurrence of any of the following events.
Note: This tax is paid once for each period that begins • As the surviving spouse or child, executor,
July 1. If you’re required to file a supplemental administrator, or other legal representative, you continue
registration, don’t pay the tax a second time. for the remainder of the period the business of a
If you start $500 $50 deceased person who paid the occupational tax.
accepting tax tax • As a receiver, trustee in bankruptcy, or assignee for
wagers in creditors, you continue the business for the remainder of
July . . . . . . . $500.00 . . . . $50.00 the period.
August . . . . . . 458.33 . . . . 45.83 • There is a change of members of a partnership which is
September . . . . 416.66 . . . . 41.66 a principal.
October . . . . . 375.00 . . . . 37.50 • There is a name change of a corporation which is a
November . . . . 333.33 . . . . 33.33 principal.
December . . . . 291.66 . . . . 29.16 Agents. You must complete line 7 if you have
January . . . . . 250.00 . . . . 25.00 previously filed Form 11-C and are engaged to receive
wagers for another. You must register the name,
February . . . . . 208.33 . . . . 20.83
address, and EIN of each new person who engaged you
March . . . . . . 166.66 . . . . 16.66 within 10 days after being engaged.
April . . . . . . . 125.00 . . . . 12.50 How to file a supplemental registration. Complete the
May . . . . . . . 83.33 . . . . 8.33 name, address, EIN, business address, and alias lines.
June . . . . . . 41.66 . . . . 4.16 • Check the “supplemental registration” box.
Payment voucher. Complete Form 11-C(V), Payment • Check the applicable box on line 3 and enter the
Voucher, and file it with Form 11-C and your payment. information that has changed on line 7, including the date
Line 3. You must check one of the boxes. See Who must of the event of change.
file, earlier, for the definition of principal and agent. • Don’t complete lines 1, 2, 4, 5, or 6 for a supplemental
Principals are liable for the excise tax on wagers, which is registration.
reported and filed monthly on Form 730.
Paid Preparer Use Only
Lines 4 and 5. These lines are to be completed by
principals only. Enter applicable information for officers A paid preparer must sign Form 11-C and provide the
and/or partners of the company on line 4. Enter on line information in the Paid Preparer Use Only section at the
5a the name and address of each location where end of the form if the preparer was paid to prepare the
business will be conducted. Enter the number of agents form and isn’t an employee of the filing entity. The
who accept wagers for you on line 5b and their names, preparer must give you a copy of the form in addition to
addresses, and EINs on line 5c. the copy to be filed with the IRS. If you’re a paid preparer,
enter your Preparer Tax Identification Number (PTIN) in
Line 6. This line is to be completed by agents accepting
the space provided. Include your complete address. If
wagers on behalf of another. Enter the name, address,
you work for a firm, you also must enter the firm’s name
and EIN of each person or company on whose behalf you
and the EIN of the firm. However, you can’t use the PTIN
accept wagers.
of the tax preparation firm in place of your PTIN. You can
apply for a PTIN online or by filing Form W-12, IRS Paid
Preparer Tax Identification Number (PTIN) Application and
Renewal. For more information about applying for a PTIN
online, visit the IRS website at www.irs.gov/PTIN.

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Form 11-C (Rev. 12-2017) Page 5
Privacy Act and Paperwork Reduction The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
Act Notice burden for this form is: Recordkeeping, 3 hr., 49 min.;
We ask for the information on Form 11-C to carry out the Learning about the law or the form, 57 min.; Preparing
Internal Revenue laws of the United States. You’re the form, 2 hr., 0 min.; and Copying, assembling, and
required to give us the information. We need it to ensure sending the form to the IRS, 16 min.
that you’re complying with these laws and to allow us to If you have comments concerning the accuracy of
figure and collect the right amount of tax. Section 4411 these time estimates or suggestions for making this form
imposes a special tax on each person who is engaged in simpler, we’d be happy to hear from you. You can send
receiving wagers for or on behalf of any person liable for us comments from www.irs.gov/FormComments. Or you
the tax on wagers. Section 4412 requires that person to can write to:
register with the IRS. Form 11-C is used to determine the
Internal Revenue Service
amount of the tax you owe and to register certain
Tax Forms and Publications
information with the IRS. Section 6109 requires you to
1111 Constitution Ave. NW, IR-6526
provide your identification number. Unless specifically
Washington, DC 20224
prohibited by law, routine uses of this information include
giving it to the Department of Justice for civil and criminal Don’t send the form to this address. Instead, see
litigation; to cities, states, the District of Columbia, and Where to file, earlier.
U.S. commonwealths and possessions 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.
You aren't 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.

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Form 11-C(V),
Payment Voucher

Purpose of Form Box 2. Enter the amount paid with Form 11-C.
Complete Form 11-C(V), Payment Voucher, and file it Box 3. Enter the same year and month you entered on
with Form 11-C, Occupational Tax and Registration the “Return for period from” line at the top of Form 11-C.
Return for Wagering. We will use Form 11-C(V) to credit For example, if your return is for the full period that begins
your payment more promptly and accurately, and to July 1, 2017, enter 201707.
improve our service to you. Box 4. Enter your name and address as shown on Form
If you have your return prepared by a third party, 11-C.
provide Form 11-C(V) to the return preparer. • Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
Specific Instructions “Form 11-C,” and the tax period on your check or money
Box 1. If you don’t have an EIN, apply for one online. Go order. Don’t send cash. Don’t staple Form 11-C(V) or your
to the IRS website at www.irs.gov/EIN. You also may payment to Form 11-C (or to each other).
apply for an EIN by faxing or mailing Form SS-4,
• Detach Form 11-C(V) and send it with your payment
Application for Employer Identification Number, to the
and Form 11-C. See Where to file, earlier.
IRS.

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

Form 11-C(V) Payment Voucher OMB No. 1545-0236
(Rev. December 2017)
Department of the Treasury
Internal Revenue Service ▶ Don’t staple or attach this voucher to your payment or Form 11-C.
1 Enter your employer identification 2 Dollars Cents
number. Enter the amount of your payment. ▶
Make your check or money order payable to “United States Treasury”
3 Enter year and month as shown on Form 11-C. 4 Enter your business name (individual name if sole proprietor).
Y Y Y Y M M
Enter your address.
Send Form 11-C, this voucher, and payment to:
Department of the Treasury Enter your city or town, state or province, country, and ZIP or foreign postal code.
Internal Revenue Service
Ogden, UT 84201-0101

PDF file checksum: 1546477828

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