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Form 6197
(Rev. October 2005)
Gas Guzzler Tax OMB No. 1545-0242
䊳 See instructions on back.
Department of the Treasury
Internal Revenue Service 䊳 Attach to Form 720.
Name (as shown on Form 720) Quarter ending Employer identification number
Line number
(e) (e)
(d) (d)
Tax due Tax due
Number Number
(b) (multiply (b) (multiply
(a) (c) of cars (a) (c) of cars
But column (c) by But column (c) by
At Tax sold At Tax sold
less column (d)) less column (d))
least rate least rate
than than
For Privacy Act and Paperwork Reduction Act Notice, see Form 720 instructions. Cat. No. 50011N Form 6197 (Rev. 10-2005)
2
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 6197, PAGE 2 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") 279mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
General Instructions Line 13. Enter on line 13 the total of all amounts in column (e).
Section references are to the Internal Revenue Code unless Example. In the second calendar quarter of 2006, a
otherwise noted. manufacturer sold: