3.24.23. Excise Tax Returns

(1)

Service Center (SC) Block Control

ABC

The screen displays the Alphanumeric Block Control (ABC) that was entered in the Entry Operator (EOP) Dialog window. It cannot be changed.

(2)

Block Document Locator Number (DLN)

DLN

(auto)

Enter the first 11 digits from:
(a) Form 813— the "Block DLN" box.
(b) Form 1332—the "Document Locator No." box.
(c) Form 3893— box 2.
The KV Operator will verify the DLN from the first document of the block.

(3)

Batch Number

BATCH

<Enter>

Enter the batch number from:
(a) Forms 813 and 1332—the "Batch Control Number" box.
(b) Form 3893— box 3.
If not present, enter the number from the batch transmittal sheet.

(4)

Document Count

COUNT

<Enter>

Enter the document count from:
(a) Forms 813 and 1332—the circled serial number. If a full block (100 documents) or if a number is not circled, enter 100.
(b) Form 3893 — box 4.

(5)

Prejournalized Credit Amount

CR

<Enter>

Enter the amount from:
(a) Form 813—shown as the "Total" or if adjusted, as the "Adjusted Total".
(b) Form 3893— box 5.

(6)

Filling Fields

<Enter> <Enter> <Enter> <Enter> <Enter>

Press <Enter> 5 times.

(7)

Source Code

SOURCE

<Enter>

If the control document is a Form 3893, enter from box 11 as follows:
(a) R = "Reprocessable" box checked.
(b) N = "Reinput of Unpostable" box checked.
(c) 4 = "SC Reinput" box checked.
If none of the boxes are checked, consult your supervisor who will determine if a source code is required.

(8)

Year Digit

YEAR

<Enter>

If the control document is Form 3893, enter the digit from the box 12.
This is a MUST ENTER field if the Source Code is "R", "N", or "4".

(9)

Filling Enter

<Enter>

Press <Enter>.

(10)

Remittance Processing System (RPS) Indicator

RPS

<Enter>

Enter "2" if:
(a) Forms 813 or 1332—" RPS" is edited or stamped in the upper center margin, or if RRPS appears in the header of Form 1332.
(b) Form 3893—box 13 is checked.

(1)

Section Number

SECT:

Section "01" will always be generated. No entry is required.

(2)

DLN Serial Number

SER Number

<Enter>

Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the serial number has been generated by the system, verify that it matches the document being entered.

(3)

Check Digit

CD

<Enter>

Enter the Check Digit if present.

(4)

Name Control (NC)

NC

<Enter>

If the Check Digit is not present, enter the Name Control.

(5)

Employer Identification Number (EIN)

EIN

<Enter>

Enter the EIN from the preprinted label or from EIN block.

(6)

Tax Period

TAXPR

<Enter>

Enter the Tax Period:
(a) As edited in the upper right portion of the return or
(b) As it appears under the caption "Date Quarter Ended" in the entity area of the return or on the preprinted return label in YYMM format.
  Quarter Enter As 
  Jan.-Mar. YY03
  Apr.-June YY06
  July-Sept. YY09
  Oct.-Dec. YY12

(7)

Address Check

ADDRESS CHECK?

<Enter>

Enter "Y" or "N" as appropriate.

(8)

Street Key

STREET KEY

<Enter>

Enter Street Key

(9)

ZIP Key

ZIP KEY

<Enter>

Enter ZIP Key.

(10)

Federal Tax Deposit (FTD) Penalty

FD

<Enter>

Enter the amount from line "FD" of the Penalty and Interest boxes.

(11)

Condition Codes

CCC

<Enter>

Enter the edited codes which appear in the name and address area of the return.
If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
If a "G" Condition Code is present and the return is a remittance, press <F6> after this element and proceed to Section 03.

(12)

Error Resolution system (ERS) –Action Code

ACTCD

<Enter>

Enter the edited digits in the bottom left margin.

(13)

IRS Number

IRS Number

<Enter>

Enter as follows:
(a) If only one IRS Number is underlined in the "IRS No." column of page 1 or page 2 of the return, or the IRS Number is edited in the margin to the right of line 3 or line 4 of page 3 of the return, enter this number.
(b) If more than one IRS Number is edited or underlined, press <Enter>.

(14)

Received Date

RDT

<Enter>

Enter the date as stamped or edited on the face of the return.

(15)

Penalty and Interest Code

P&I

<Enter>

Enter the edited "1" to the right of the Tax, Penalty and Interest box.

(16)

In Care of Name Line

C/O NAME

<Enter>

Enter the in care of name if shown.

(17)

Foreign Address

FGN ADD

<Enter>

Enter the foreign address information as shown or edited from the entity area.

(18)

Street Address

ADDR

<Enter>

Enter the street address information as shown or edited in the entity area of the form.

(19)

City

CITY

<Enter>

Enter the city from the entity area of the return.

(20)

State

ST

<Enter>

Enter the standard state abbreviation from the entity area of the return.

(21)

ZIP Code

ZIP

<Enter>

Enter the ZIP Code from the entity area of the return.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "02".

(2)

First Part I IRS Number

PT1 Number1

<Enter>

Enter the first Part I IRS Number that is underlined.

(3)

Tax

AMT1

<Enter>

Enter the amount corresponding to the first underlined IRS number.

(4)

Next Part I IRS Number

PT1 Number2

<Enter>

Enter the next Part I IRS Number that is underlined.

(5)

Tax

AMT2

<Enter>

Enter the amount corresponding to the next underlined IRS number.

(6) thru (43)

Additional Part I IRS Numbers and Tax

PT1Number3, AMT3 thru P1 Number21, AMT21

<Enter>

Repeat elements (4) and (5) until all underlined Part I IRS Numbers have been transcribed.

(44) thru (52)

Additional Part I IRS Numbers with Tax and Number of Tires

PT1#22, AMT22, NumberTIRES22 thru P1 Number24, AMT24, NumberTIRES24

<Enter>

Enter underlined IRS number "108", "109" and/or "113", the related tax amount(s) and the number of tires.

(53) thru (55)

Part I IRS Number with Tax (Taxable Medical Devices), and Sales Price

P1 Number25,
AMT25,
PRICE

<Enter>

Enter the underlined IRS number "136", the related tax amount, and Sales Price.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "03".

(2)

Remittance

RMT

<Enter>

Enter the green rockered amount from the balance due area of the return or from an attached cash register receipt.
If no amount is edited or the edited amount is illegible, check the control document for the correct amount.
This is a MUST ENTER field if a Prejournalized Credit Amount (prompt "CR") was entered in the Block Header.

(3)

First Part II IRS Number

PT2 Number1

<Enter>

Enter the first Part II IRS Number that is underlined.

(4)

Tax

AMT1

<Enter>

Enter the amount corresponding to the first underlined IRS number.

fields if Element (3) is "133". The first IRS Number and Tax Amount in Section 03 is dedicated to PCOR tax. If any other number is being reported on Form 720 Part II, then begin entering the other taxes with the second field in Section 03 for IRS Number and Tax Amount.

(5)

Specified Health Policies (Average Lives)

AVG Number1

<Enter>

Enter the Average. number of lives covered from line 1.

(6)

Col. (a) X Col. (b)1

(A)X(B)1

<Enter>

Enter the amount in (c) Fee (see Instructions), line 1.

(7)

Specified Health Policies (Average Livers) (b)

AVG Number 1B

<Enter>

Enter the number of Applicable Self-Insured plans from line 1b of Avg. number of lives covered.

(8)

Col. (a) X Col. (b) 1B

(A)X(B)1B

<Enter>

Enter the amount in (c) Fee (see Instructions), line 1.

(9)

Applicable Self-Insured Plans

AVG Number 2

<Enter>

Enter the number of Applicable Self-Insured plans from line 2 of Avg. number of lives covered.

(10)

Col. (a) X Col. (b)2

(A)X(B)2

<Enter>

Enter the amount in (c) Fee (see Instructions), line 2.

(11)

Applicable Self Insured Health Plans B

AVG Number2B

<Enter>

Enter the number of Applicable Self-Insured plans from line 2b of Avg. number of lives covered.

(12)

Col. (a) X Col. (b)2B

(A)X(B)2B

<Enter>

Enter the amount in (c) Fee (see Instructions), line 2b.

(13)

Next Part II IRS Number

PT2 Number2

<Enter>

Enter the next Part II IRS Number that is underlined.

(14)

Tax

AMT2

<Enter>

Enter the amount corresponding to the next underlined IRS Number.

(15) thru (34)

Additional Part II IRS Numbers and Tax

PT2 Number3 AMT3 thru P2 Number12 AMT12

<Enter>

Repeat elements (9) and (10) until all underlined Part II IRS Numbers have been entered or until a total of 12 have been entered.

(35)

Total Tax T/P Part III

PT3L3

<Enter>

Enter amount shown on line 3.

(36)

Claims/Credits

LN4

<Enter>

Enter the amount shown on Line 4.

(37)

Deposits and Prior Quarter Overpayments

LN8

<Enter>
MINUS (−)

Enter the amount shown on Line 8.

(38)

Balance Due/Overpayment

10/11

<Enter>
MINUS (−)

Enter the amount from line 10 or line 11 as follows:
(a) If the amount on line 10 is the same as the Remittance amount, press <Enter>.
(b) If the amount on line 10 is different from the Remittance amount, enter the amount from line 10 and press <Enter>.
(c) If there is no entry on line 10, enter the amount from line 11 and press MINUS(-).

(39)

Refund Indicator (RI)

RI

<Enter>

Enter "2" if the "Refunded" box is checked. Otherwise press <Enter>.

(40)

Third Party Designee Checkbox

CKBX

<Enter>

Enter "1" if only the "Yes" box is checked. Otherwise, press <Enter>.

(41)

Third Party Designee (Identification (ID) Number

ID Number

<Enter>

Enter the third party designee ID Number.

(42)

Preparer's Taxpayer Identification Number (PTIN)

PTIN

<Enter>

Enter the Paid Preparer's PTIN.

(43)

Preparer's Employer Identification Number (PEIN)

PEIN

<Enter>

Enter the Preparer's EIN.

(44)

Preparer's Telephone Number

TEL Number

<Enter>

Enter the Preparer's telephone number.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "04".

(2)

Record of Liability

LNA

<Enter>
MINUS (−)

Enter the amount from Schedule A, line a.

(3)

Record of Liability

LNB

<Enter>
MINUS (−)

Enter the amount from Schedule A, line b.

(4)

Record of Liability

LNC

<Enter>
MINUS (−)

Enter the amount from Schedule A, line c.

(5)

Record of Liability

LND

<Enter>
MINUS (−)

Enter the amount from Schedule A, line d.

(6)

Record of Liability

LNE

<Enter>
MINUS (−)

Enter the amount from Schedule A, line e.

(7)

Record of Liability

LNF

<Enter>
MINUS (−)

Enter the amount from Schedule A, line f.

(8)

Special Rule for September

SPECAB

<Enter>
MINUS (−)

Enter the amount from line 1(a)G or line 2(a)S, whichever is present.
If both are present, enter from line 1(a)G.

(9)

Record of Liability

LNM

<Enter>
MINUS (−)

Enter the amount from Schedule A, line m.

(10)

Record of Liability

LNN

<Enter>
MINUS (−)

Enter the amount from Schedule A, line n.

(11)

Record of Liability

LNO

<Enter>
MINUS (−)

Enter the amount from Schedule A, line o.

(12)

Record of Liability

LNP

<Enter>
MINUS (−)

Enter the amount from Schedule A, line p.

(13)

Record of Liability

LNQ

<Enter>
MINUS (−)

Enter the amount from Schedule A, line q.

(14)

Record of Liability

LNR

<Enter>
MINUS (−)

Enter the amount from Schedule A, line r.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "05".

(2)

Credit Reference Number1

CRN1

<Enter>

Enter the first CRN that has a related amount.

(3)

Amount of Claim Number1

AMT1

<Enter>

Enter the first amount.

(4)

Credit Reference Number2

CRN2

<Enter>

Enter the next CRN that has a related amount.

(5)

Amount of Claim Number2

AMT2

<Enter>

Enter the next amount.

(6) thru (37)

Additional Credit References with Claim Amount(s)

CRN3 AMT3 thru CRN18 AMT18

<Enter>

Repeat elements (4) and (5) until all CRNs that have related amounts have been transcribed or until a total of 18 CRNs have been transcribed. Additional CRNs can be entered in Section 06.

(38) thru (46)

Additional CRNs with Claim Amount(s) and Number of Tires

CRN19, AMT 19, Number of TIRES19 thru CRN 21, AMT 21, Number of TIRES21

<Enter>

Enter CRN "304", "305" and/or "396", the related credit reference amount(s) and the number of tires if present.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "06".

(2)

Credit Reference Number 22

CRN22

<Enter>

Enter the next CRN that has a related amount.

(3)

Amount of Claim Number 22

AMT22

<Enter>

Enter the corresponding amount.

(4)

Credit Reference Number 23

CRN23

<Enter>

Enter the next CRN that has a related amount.

(5)

Amount of Claim Number 23

AMT23

<Enter>

Enter the corresponding amount.

(6) thru (35)

Additional Credit References and Amounts of Claim

CRN24 AMT24 thru CRN38 AMT38

<Enter>

Repeat elements (4) and (5) until all CRNs that have related amounts have been transcribed.

(1)

Section Number

SECT:

Section "01" will always be generated. No entry is required.

(2)

DLN Serial Number

SER Number

<Enter>

Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the serial number has been generated by the system, verify that it matches the document being entered.

(3)

Check Digit

CD

<Enter>

Enter the Check Digit if present.

(4)

Name Control

NC

<Enter>

If the Check Digit is not present, enter the Name Control.

(5)

EIN

EIN

Enter the EIN from the preprinted label or from EIN block.

(6)

Address Check

ADDRESS CHECK?

Enter "Y" or "N" as appropriate.

(7)

Street Key

STREET KEY

<Enter>

Enter the Street Key.

(8)

ZIP KEY

ZIP KEY

<Enter>

Enter the ZIP Key.

(9)

Tax Period

TAXPR

<Enter>

Enter the Tax Period edited or underlined in YYMM format as it appears to the left of OMB Number.

(10)

Condition Codes

CCC

<Enter>

Enter the edited codes listed to the right of the Name and Address area.

(11)

ERS—Action Code

ACTCD

<Enter>

Enter the edited digits in the bottom left margin.

(12)

Received Date

RDT

<Enter>

Enter the date as stamped or edited on the face of the return.
If a "G" Condition Code is present and the return is a non-remittance, press <F6> to skip to COND IND prompt and enter as instructed, then end the document.
If a "G" Condition Code is present and the return is a remittance, press <F6> to proceed to Section 03.

(13)

Penalty and Interest Code

P&I

<Enter>

Enter the edited digit from the margin to the right of the "Penalty/Interest" box.

(14)

Additional Tax

LN3

<Enter>

Enter the amount from line 3.

(15)

Total Tax Adjusted

LN4

<Enter>

Enter the amount from line 4.

(16)

Credits

LN5

<Enter>

Enter the amount from line 5.

(17)

Balance Due/Overpayment

LN6

<Enter>
MINUS (−)

Enter the amount from line 6.

(18)

Third Party Designee Checkbox

CKBX

<Enter>

Enter "1" if only the "Yes" box is checked. Otherwise, press <Enter>.

(19)

Third Party Designee ID Number

ID Number

<Enter>

Enter the third party designee ID number.

(20)

Preparer's PTIN or SSN

PSSN

<Enter>

Enter the Preparer's PTIN or SSN.

(21)

Preparer's EIN

PEIN

<Enter>

Enter the Preparer's EIN.

(22)

Preparer's Telephone Number

TEL Number

<Enter>

Enter the Preparer's telephone number.

(23)

Consent to Disclosure of Tax Information Indicator

CONSENT-IND

<Enter>

This is a must enter field:
0 = The consent to disclose statement is not signed or not attached.
1 = The consent to disclose statement is attached and signed.
Enter the edited 0 (zero) or 1 (one) from the bottom center of the form.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "02".

(2)

In Care of Name Line

C/O NAME

<ENTER>

Enter the in care of name.

(3)

Foreign Address

FGN ADD

<ENTER>

Enter the foreign address information as shown or edited from the entity area.

(4)

Street Address

ADDR

<ENTER>

Enter the street address information as shown or edited in the entity area of the form.

(5)

City

CITY

<ENTER>

Enter the city from the entity area of the return.

(6)

State

ST

<ENTER>

Enter the standard state abbreviation from the entity area of the return.

(7)

ZIP Code

ZIP

<ENTER>

Enter the ZIP Code from the entity area of the return.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "03".

(2)

Remittance

RMT

<Enter>

Enter the green rockered amount from the balance due area of the return or an attached cash register receipt.
If no amount is edited or the edited amount is illegible, check the control document (Form 813 or Form 3926) for the correct amount.
This is a MUST ENTER field if a Prejournalized Credit Amount (prompt CR) was entered in the Block Header.

(3)

Vehicle Category

CAT Number1

<Enter>

Enter the alpha character from the left side of the return under title "Category" for the first category with a numeric entry for item (3)(a) and/or (3)(b).

(4)

Number of Vehicles

3A Number1

<Enter>

Enter the number from the right side of the return under title "Number of Vehicles (3)(a)".

(5)

Number of Vehicles

3B Number1

<Enter>

Enter the number from the right side of the return under title "Number of Vehicles (3)(b)".

(6) thru (38)

Additional Vehicle Categories and Number of Vehicles

CAT Number2 thru 3B12

<Enter>

Enter additional Vehicle Categories and Number of Vehicles as in E–(3) thru E–(5) above.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "04".

(2) thru (34)

Additional Vehicle Categories and Number of Vehicles

CAT13 thru 3B23

<Enter>

Enter additional Categories and Number of Vehicles as in Section 03.

(1)

Section Number

SECT:

Section "01" will always be generated. No entry is required.

(2)

DLN Serial Number

SER Number

<Enter>

Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the serial number has been generated by the system, verify that it matches the document being entered.

(3)

Check Digit

CD

<Enter>

Enter the Check Digit if present.

(4)

Name Control

NC

<Enter>

If the Check Digit is not present, enter the Name Control.

(5)

TIN

TIN

<Enter>

Enter the EIN/SSN from the preprinted label or from Number block.

(6)

Address Check

ADDRESS CHECK?

<Enter>

Enter "Y" or "N" as appropriate.

(7)

TIN Type

TYPE

<Enter>

Enter a zero (0) if the TIN is a social security number.
If unable to determine, press <Enter>.

(8)

Beginning Year-Month

TAXPR

<Enter>

Enter the tax period:
(a) edited to the left of the OMB Number, or
(b) from the pre-printed label.

(9)

Condition Codes

CC

<Enter>

Enter the edited codes listed to the right entity area.

(10)

Received Date

RDATE

<Enter>

Enter the date as stamped or edited on the face of the return.
If a "G" Condition Code is present and the return is a non-remittance end the document after this element.
If a "G" Condition Code is present and the return is a remittance press <F6> and proceed to Section 03.

(11)

Tax

PT1L2

<Enter>

Enter the amount shown or edited from Part I, Line 2

(12)

Penalty and Interest Code

P&I

<Enter>

Enter the edited digit from the upper right margin of the return.

(13)

Nature of Change Indicator

CHANGE

<Enter>

Enter the edited digit from the left margin of Part I, line 3.

(14)

Start Day

START

<Enter>

Enter the edited digits beneath "Return for period from."

(15)

"S" Indicator

S

<Enter>

Press <Enter>.

(16)

Part II Line 5 Question

PT2L5?

<Enter>

Enter the edited digit from the right margin of Part II, Line 5.

(17)

Preparer's SSN/PTIN

PSSN

<Enter>

Enter the Preparer's SSN or PTIN.

(18)

Preparer's EIN

PEIN

<Enter>

Enter the Preparer's EIN.

(19)

Preparer's Telephone Number

TEL Number

<Enter>

Enter the Preparer's telephone number.

(20)

Street Key

STREET KEY

<Enter>

Enter the Street Key.

(21)

ZIP Key

ZIP KEY

<Enter>

Enter the ZIP Key.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "02".

(2)

In Care of Name Line

C/O NAME

<ENTER>

Enter the in care of name.

(3)

Foreign Address

FGN ADD

<ENTER>

Enter the foreign address information as shown or edited from the entity area.

(4)

Street Address

ADDR

<ENTER>

Enter the street address information as shown or edited in the entity area of the form.

(5)

City

CITY

<ENTER>

Enter the city from the entity area of the return.

(6)

State

ST

<ENTER>

Enter the standard state abbreviation from the entity area of the return.

(7)

ZIP Code

ZIP

<ENTER>

Enter the ZIP Code from the entity area of the return.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "03".

(2)

Remittance Amount

RMT

<Enter>

Enter the green rockered amount from the balance due area of the return or an attached cash register receipt.
If no amount is edited or the edited amount is illegible, check the control document (Form 813 or Form 3926) for the correct amount.
This is a MUST ENTER field if a Prejournalized Credit Amount (prompt "CR") was entered in the Block Header.

(1)

Section Number

SECT:

Section "01" will always be generated. No entry is required.

(2)

DLN Serial Number

SER Number

<Enter>

Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the serial number has been generated by the system, verify that it matches the document being entered.

(3)

Check Digit

CD

<Enter>

Enter the Check Digit if present.

(4)

Name Control

NC

<Enter>

If the Check Digit is not present, enter the Name Control.

(5)

EIN

EIN

Enter the EIN from the preprinted label or from EIN block.

(6)

Address Check

ADDRESS CHECK?

Enter "Y" or "N" as appropriate.

(7)

Street Key

STREET KEY

<Enter>

Enter the Street Key.

(8)

ZIP KEY

ZIP KEY

<Enter>

Enter the ZIP Key

(9)

Tax Period-Beginning

TAXPR

<Enter>

Enter the edited Tax Period to the left of the OMB Number.

(10)

Received Date

RDATE

<Enter>

Enter the date as stamped or edited in MMDDYYYY format on the face of the return.

(11)

Condition Codes

CC

<Enter>

Enter the edited codes shown to the right of the name and address area.
If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
If a "G" Condition Code is present and the return is a remittance, press <F6> and proceed to Section 03.

(12)

Penalty and Interest Code

P&I

<Enter>

Enter the edited digit to the right of the "Tax, Penalty and Interest" box.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "02".

(2)

In Care of Name Line

C/O NAME

<ENTER>

Enter the in care of name.

(3)

Foreign Address

FGN ADD

<ENTER>

Enter the foreign address information as shown or edited from the entity area.

(4)

Street Address

ADDR

<ENTER>

Enter the street address information as shown or edited in the entity area of the form.

(5)

City

CITY

<ENTER>

Enter the city from the entity area of the return.

(6)

State

ST

<ENTER>

Enter the standard state abbreviation from the entity area of the return.

(7)

ZIP Code

ZIP

<ENTER>

Enter the ZIP Code from the entity area of the return.

(1)

Section Number

SECT:

<Enter>

Press <Enter> if already present on the screen; otherwise enter "03".

(2)

Remittance

RMT

<Enter>

Enter the green rockered amount from the balance due area of the return or an attached cash register receipt.
If no amount is edited or the edited amount is illegible, check the control document (Form 813 or Form 3926) for the correct amount.
This is a MUST ENTER field if a Prejournalized Credit Amount (prompt "CR") was entered in the Block Header.

(3)

Wagers Accepted

LN1

<Enter>

Enter the amount shown on Line 1, titled "Gross Wagers Accepted During Month …"

(4)

Wagers Lay-Off Accepted

LN2

<Enter>

Enter the amount shown on Line 2 titled "Gross Amount of Lay-Off Wagers Accepted During Month …".

(5)

Gross Wagers Authorized

L4A

<Enter>

Enter the amount shown or edited from the center of line 4a.

(6)

Gross Wagers Other Than

L4B

<Enter>

Enter the amount shown or edited from the center of line 4b.

(7)

Credit

LN5

<Enter>

Enter the amount shown on Line 5 titled "Lay-Off Credits …"

(8)

Balance Due/Overpayment

LN6

<Enter>
MINUS (-)

Enter the amount from Line 6.

(9)

Preparer's PTIN or SSN

PSSN

<Enter>

Enter the Preparer's PTIN or SSN.

(10)

Preparer's EIN

PEIN

<Enter>

Enter the Preparer's EIN.

(11)

Preparer's Telephone Number

TEL Number

<Enter>

Enter the Preparer's telephone number.