Form 11-C Occupational Tax and Registration Return for Wagering

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Form  	11-C 	(Rev. September 2016) Department of the Treasury  
Internal Revenue Service 	
Occupational Tax and Registration Return for Wagering 	
▶ Information about Form 11-C and its instructions is at www.irs.gov/form11c. 	
Return for period from 	
(Month and day) 	, 	(Year) 	
to June 30, 	
(Year) 	
OMB No. 1545-0236	
Type or 
Print	
Name 	Employer identification number 	
Number, street, and room or suite no. 
City or town, state or province, country, and ZIP or foreign postal code\
 	
Check one: 	First return 	Renewal return 	
Supplemental registration (Do not complete lines 1, 2, 4, 5, and 6.) 	
Daytime telephone number	
Business address (if different from your home address or address entere\
d above) 
Alias, style, or trade name, if any 	
For IRS Use Only 	
T  $ 	1 	
FF 	2 	
FP 	3 	
I 	4 	
T  $ 	5 	Part I 	Occupational Tax 	
1  Enter the date (month and day) you will 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 p\
ayments. 
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 na\
me 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 yo\
ur 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 cod\
e	
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. 9-2016)

Form 11-C (Rev. 9-2016) 	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 are filing a supplemental registration. Include the date\
 of the event. 	
Sign 
Here	
Under penalties of perjury, I declare that I have examined this return a\
nd/or registration (including any accompanying statements or lists), a\
nd to the best of 
my knowledge and belief, it is true, correct, and complete. Declaration \
of preparer (other than taxpayer) is based on all information of which\
 preparer has any 
knowledge.
▲
Signature of officer	Date	
▲
Title	
Paid 
Preparer 
Use Only	Print/Type preparer’s name	Preparer’s signature	Date	Check         if 
self-employed	PTIN	
Firm’s name      	▶	
Firm’s address  	▶	
Firm’s EIN  	▶	
Phone no.
Form  	
11-C 	 (Rev. 9-2016)

Form 11-C (Rev. 9-2016) 	Page  	3 
Section references are to the Internal Revenue Code 
unless otherwise noted.	
Future Developments 
For the latest information about developments related to 
Form 11-C and its instructions, such as legislation 
enacted after they were published, go to www.irs.gov/
form11c. 
General Instructions 
Purpose of form. Form 11-C is used to register certain 
information with the IRS and to pay the occupational tax 
on wagering. You must pay the occupational tax if you 
accept taxable wagers for yourself or another person. 
There are two amounts of occupational tax ($50 or $500). 
One or the other applies depending on whether the 
wagers you accept are authorized by the laws of the state 
in which you accept the wager. See Line 2 later to 
determine your occupational tax. Your cancelled check is 
proof of registration and payment. 
Who must file. File Form 11-C if you are a principal or an 
agent.  1. A principal is a person who is in the business of  
accepting taxable wagers for his or her own account.  
This is the person who makes a profit or risks loss  
depending on the outcome of the event or contest for  
which the wager is accepted. 
2. An agent is a person who accepts taxable wagers  
on the principal’s behalf. 
Taxable wagers include those placed: 
• On a sports event or contest with a person engaged in 
the business of accepting wagers on a sports event or 
contest. 
• In a wagering pool on a sports event or contest if the  
pool is conducted for profit. 
• In a lottery conducted for profit (other than a state-
conducted lottery). The term lottery includes the numbers 
game, policy, punch boards, and similar types of 
wagering. 
What is not taxed.  The tax is not imposed on the  
following five items. 
• A parimutuel wagering enterprise, including horse  
racing, dog racing, and jai alai, when licensed under the 
laws of the state in which accepted.
• Coin-operated devices, such as pinball machines.
• Sweepstakes, wagering pools, or lotteries that are  
conducted by an agency of a state, if the wager is placed 
with the state agency or its authorized agents or 
employees.
• Games of the type in which usually all persons placing 
wagers in the game are present when wagers are placed, 
winners are determined, and prizes or other property are 
distributed.
• Drawings conducted by an organization exempt from  
tax under sections 501 or 521, as long as the net  
proceeds of the drawing do not inure to the benefit of a 
private shareholder or individual. Definitions. See the Instructions for Form 730, Monthly 
Tax Return for Wagers, for the definition of sports event, 
contest, wagering pool, and lottery. 
When to file. File the first return before wagers are  
accepted. After that, file a renewal return by July 1 for  
each year wagers are accepted. A first return is also due 
in certain situations in which there has been a change in 
ownership or control. The return must be filed within 30 
days after new members are admitted to a firm or 
partnership, a corporation is formed to continue the 
business of a partnership, or a stockholder continues the 
business of a dissolved corporation. 
Employer Identification Number (EIN). Enter your EIN. If 
you do not have an EIN, apply for one online. Go to the 
IRS website at www.irs.gov/businesses/small and click 
on the "Employer ID Numbers" link. You may also apply 
for an EIN by faxing or mailing Form SS-4, Application for 
Employer Identification Number, to the IRS.
Address. If you are an individual, enter your home  
address. 
Signature. Form 11-C must be signed by a person who 
has authority to sign for the taxpayer. 
Where to file. Send Form 11-C, your check or money  
order, and Form 11-C(V) to: 
Department of the Treasury                                   
Internal Revenue Service                                 
Cincinnati, OH 45999-0101 
Send the return using the U.S. Postal Service or other  
designated private delivery service. See the instructions 
for your income tax return for more information about 
private delivery services. 
Penalties. There are penalties for not filing on time, for  
accepting wagers before paying the tax, and for willfully 
failing to file the return. There are also penalties for 
making, or helping to make, false returns, documents, or 
statements. 
If you receive a notice about a penalty after you file this 
return, reply to the notice with an explanation and we will 
determine if you meet reasonable-cause criteria. Do not 
attach an explanation when you file your return.
Disclosure of information on wagering taxes. Except  
for administering or enforcing Internal Revenue taxes,  
neither the Treasury Department nor any of its  
employees may disclose documents, records, or  
information obtained through them that a taxpayer  
supplies in connection with wagering taxes. Also, certain 
documents related to wagering taxes and information 
obtained through them that relates to wagering taxes may 
not be used against the taxpayer in any nontax criminal 
proceeding. See section 4424 for more details. 	
Refund. A refund for an overpayment of the occupational 
tax may be claimed on Form 8849, Claim for Refund of 
Excise Taxes, using Schedule 6 (Form 8849), Other 
Claims. See the Instructions for Form 8849 for details. 
Specific Instructions 
Return period. Enter the month, day, and year the return 
period begins. Also, enter the ending year. Write the year 
as a four-digit number (for example, 2016 or 2017).

Form 11-C (Rev. 9-2016) 	Page  	4 
Line 1. Enter the day and month that you will start  
accepting wagers. A full month’s tax is due regardless of 
which day you start accepting wagers during a month. 
Line 2. Use the table below to determine the tax. The  
$50 tax applies if all wagers (including those accepted  by 
an agent for another) are authorized under the laws of the 
state in which accepted. If you intend to accept wagers 
that are not authorized by the state, the $500 tax applies. 
The tax is payable for the period that begins July 1 of 
each year. If you start accepting wagers after July 31, the 
tax is prorated for the first year. 
Note: This tax is paid once for each period that begins  
July 1. If you are required to file a supplemental  
registration, do not pay the tax a second time. 
If you start  accepting  wagers in  $500  
tax 
$50  
tax 
July  ....... $500.00  .... $50.00 
August  ......  458.33  .... 45.83
September  ....  416.66  .... 41.66
October  .....  375.00  .... 37.50
November  ....  333.33  .... 33.33
December  ....  291.66  .... 29.16
January  .....  250.00  .... 25.00
February  .....  208.33  .... 20.83
March  ......  166.66  .... 16.66
April  .......  125.00  .... 12.50
May  .......    83.33  ....   8.33
June  ......    41.66  ....   4.16
Payment voucher. Complete Form 11-C(V), Payment  
Voucher, and file it with Form 11-C and your payment. 
Line 3. You must check one of the boxes. See Who must 
file for the definition of principal and agent. Principals are 
liable for the excise tax on wagers, which is reported and 
filed monthly on Form 730. 
Lines 4 and 5. These lines are to be completed by  
principals only. Enter applicable information for officers   
and/or partners of the company on line 4. Enter on line  
5a the name and address of each location where  
business will be conducted. Enter the number of agents 
who accept wagers for you on line 5b and their names, 
addresses, and EINs on line 5c. 
Line 6. This line is to be completed by agents accepting 
wagers on behalf of another. Enter the name, address, 
and EIN of each person or company on whose behalf you 
accept wagers. 	
Supplemental Registration 
Line 7. If you, as a principal, change your home or 
business address, you must file a supplemental 
registration before accepting wagers at the new address 
or by the end of the 30-day period after the change, 
whichever occurs first. If you engage a new agent to 
receive wagers, you must file, within 10 days of engaging 
the agent, a supplemental registration reporting the 
agent's name, address, and EIN.
You must file a supplemental registration within 30 
days of the occurrence of any of the following events.
• As the surviving spouse or child, executor, 
administrator, or other legal representative, you continue 
for the remainder of the period the business of a 
deceased person who paid the occupational tax.
• As a receiver, trustee in bankruptcy, or assignee for 
creditors, you continue the business for the remainder of 
the period. 
• There is a change of members of a partnership which is 
a principal.
• There is a name change of a corporation which is a 
principal.
Agents. You must complete line 7 if you have  
previously filed Form 11-C and are engaged to receive  
wagers for another. You must register the name,  
address, and EIN of each new person who engaged you 
within 10 days after being engaged. 
How to file a supplemental registration. Complete the 
name, address, EIN, business address, and alias lines.
• Check the “supplemental registration” box.
• Check the applicable box on line 3 and enter the 
information that has changed on line 7, including the date 
of the event of change.
• Do not complete lines 1, 2, 4, 5, or 6 for a supplemental 
registration. 
Paid Preparer Use Only 
A paid preparer must sign Form 11-C and provide the 
information in the Paid Preparer Use Only section at the 
end of the form if the preparer was paid to prepare the 
form and is not an employee of the filing entity. The 
preparer must give you a copy of the form in addition to 
the copy to be filed with the IRS. If you are a paid 
preparer, enter your Preparer Tax Identification Number 
(PTIN) in the space provided. Include your complete 
address. If you work for a firm, you also must enter the 
firm's name and the EIN of the firm. However, you cannot 
use the PTIN 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.

Form 11-C (Rev. 9-2016) 	Page  	5 	
Privacy Act and Paperwork Reduction 
Act Notice 
We ask for the information on Form 11-C to carry out the 
Internal Revenue laws of the United States. You are 
required to give us the information. We need it to ensure 
that you are complying with these laws and to allow us to 
figure and collect the right amount of tax. Section 4411 
imposes a special tax on each person who is engaged in 
receiving wagers for or on behalf of any person liable for 
the tax on wagers. Section 4412 requires that person to 
register with the IRS. Form 11-C is used to determine the 
amount of the tax you owe and to register certain 
information with the IRS. Section 6109 requires you to 
provide your identification number. Unless specifically 
prohibited by law, routine uses of this information include 
giving it to the Department of Justice for civil and criminal 
litigation; to cities, states, the District of Columbia, and  
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 are not 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.  The time needed to complete and file this form will vary 
depending on individual circumstances. The estimated 
burden for businesses is approved under OMB number 
1545-0123, and the estimated burden for all others who 
file this form is: Recordkeeping, 3 hrs., 49  min.; 
Learning about the law or the form, 57 min.;  Preparing 
the form, 2 hrs., 0 min.; and Copying,  assembling, and 
sending the form to the IRS, 16 min. 
If you have suggestions for making this form simpler, 
we would be happy to hear from you. You can send us 
comments from www.irs.gov/formspubs/. Click on “More 
Information” and then on “Comment on Tax Forms and 
Publications.” Or you can send your comments to:
Internal Revenue Service                                            
Tax Forms and Publications                                         
SE:W:CAR:MP:TFP                                                     
1111 Constitution Ave. NW, IR-6526             
Washington, DC 20224
Do not send the form to this address. Instead, see 
Where to file, earlier. 
We respond to many letters by telephone. Therefore, it 
would be helpful if you would include your daytime phone 
number, including the area code, in your correspondence.
Although we cannot respond individually to each 
comment received, we do appreciate your feedback and 
will consider your comments as we revise our tax 
products.

Form 11-C(V), 
Payment Voucher 
Purpose of Form 
Complete Form 11-C(V), Payment Voucher, and file it  
with Form 11-C, Occupational Tax and Registration  
Return for Wagering. We will use Form 11-C(V) to credit 
your payment more promptly and accurately, and to 
improve our service to you. If you have your return prepared by a third party,  
provide Form 11-C(V) to the return preparer. 
Specific Instructions 
Box 1. If you do not have an EIN, apply for one online.  
Go to the IRS website at www.irs.gov/businesses/small  
and click on the “Employer ID Numbers” link. You may  
also apply for an EIN by faxing or mailing Form SS-4, 
Application for Employer Identification Number, to the 
IRS.  Box 2. Enter the amount paid with Form 11-C. 
Box 3. Enter the same year and month you entered on  
the “Return for period from” line at the top of Form 11-C. 
For example, if your return is for the full period that begins 
July 1, 2017, enter 201707. 
Box 4. Enter your name and address as shown on Form 
11-C. 
• Enclose your check or money order made payable to 
“United States Treasury.” Be sure to enter your EIN, 
“Form 11-C,” and the tax period on your check or money 
order. Do not send cash. Do not staple Form 11-C(V) or 
your payment to Form 11-C (or to each other). 
• Detach Form 11-C(V) and send it with your payment  
and Form 11-C. See Where to file earlier. 	
▼     Detach Here and Mail With Your Payment and Form 11-C.     	▼	
Form 11-C(V) 	
(Rev. September 2016) Department of the Treasury  
Internal Revenue Service 	
Payment Voucher 	
▶ Do not staple or attach this voucher to your payment or Form 11-C. 	
OMB No. 1545-0236	
1 Enter your employer identification 
number. 	2 Enter the amount of your payment. 	▶ 	Make your check or money order payable to “United States Treasury”\
	
Dollars 	Cents 
3 	
Enter year and month as shown on Form 11-C. 
Y	Y	Y	Y	M	M	
Send Form 11-C, this voucher, and payment to:    Department of the Treasury Internal Revenue Service 
Cincinnati, OH 45999-0101 	
4 	Enter your business name (individual name if sole proprietor). 
Enter your address. 
Enter your city or town, state or province, country, and ZIP or foreign \
postal code.