Other Claims

• Legal Form Number: 8849 (Schedule 6)
• Year: 2013
• Issuer: Treasury Department
• Section: Treasury Department

Schedule 6

(Form 8849)

(Rev. August 2013)

Department of the Treasury

Internal Revenue Service

Other Claims

▶ Attach to Form 8849.

▶ Information about Schedule 6 (Form 8849) and its instructions, is at www.irs.gov/form8849.

OMB No. 1545-1420

Name as shown on Form 8849 EIN or SSN Total refund (total of lines 1–5)

$

Enter the earliest and latest dates of the events included in this claim. Enter in MMDDYYYY format.

Earliest date ▶Latest date ▶

Tax Amount of refund CRN

1

$

2

3

4

5

Use the space below for an explanation of each tax claimed.

For claims under section 6416(b)(2) relating to certain uses and resales of certain articles subject to manufacturers or retailers

taxes, claimant certifies that it sold the article at a tax-excluded price, repaid the amount of tax to the ultimate vendor, or has

obtained the written consent of the ultimate vendor to make the claim; and has the required supporting evidence.

For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions. Cat. No. 27454M Schedule 6 (Form 8849) (Rev. 8-2013)