0126 Form 6627 (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f6627.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

6627 Form (Rev. January 2026) Department of the Treasury Internal Revenue Service	Environmental Taxes Attach to Form 720. Go to www.irs.gov/Form6627 for instructions and the latest information.					OMB No. 1545-0023
Name (as shown on Form 720)	Name (as shown on Form 720)	Quarter ending	Quarter ending	Quarter ending	Employer identification number (EIN)	Employer identification number (EIN)
Part I Tax on Petroleum	Part I Tax on Petroleum	Part I Tax on Petroleum	(a) Barrels	(b) Rate	(b) Rate	(c) Tax
1 Crude oil received at a U.S. refinery . . . . . . . . . . . .
2 Crude oil taxed before receipt at refinery . . . . . . . . . .
3 Taxable crude oil. Subtract line 2 from line 1. Enter the result on both lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines. (a) (b)	3 Taxable crude oil. Subtract line 2 from line 1. Enter the result on both lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines. (a) (b)	3 Taxable crude oil. Subtract line 2 from line 1. Enter the result on both lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines. (a) (b)		$ .18 bbl	$ .18 bbl	$
3 Taxable crude oil. Subtract line 2 from line 1. Enter the result on both lines 3(a) and 3(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines. (a) (b)
4 Crude oil used in the U.S. before the tax was imposed. Multiply column (a) by column (b) and enter the amount of tax in column (c). Enter on both lines 4(a) and 4(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines.(a) (b)	4 Crude oil used in the U.S. before the tax was imposed. Multiply column (a) by column (b) and enter the amount of tax in column (c). Enter on both lines 4(a) and 4(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines.(a) (b)	4 Crude oil used in the U.S. before the tax was imposed. Multiply column (a) by column (b) and enter the amount of tax in column (c). Enter on both lines 4(a) and 4(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines.(a) (b)		$ .18 bbl	$ .18 bbl	$
4 Crude oil used in the U.S. before the tax was imposed. Multiply column (a) by column (b) and enter the amount of tax in column (c). Enter on both lines 4(a) and 4(b), column (a). Enter in column (c) the amount of tax by multiplying column (a) by column (b) for both lines.(a) (b)
5 Total domestic petroleum superfund tax (add lines 3(a) and 4(a), column (c)). Enter here and on Form 720 on the line forIRS No. 53 . . . .	5 Total domestic petroleum superfund tax (add lines 3(a) and 4(a), column (c)). Enter here and on Form 720 on the line forIRS No. 53 . . . .	5 Total domestic petroleum superfund tax (add lines 3(a) and 4(a), column (c)). Enter here and on Form 720 on the line forIRS No. 53 . . . .				$
6 Total domestic petroleum oil spill tax. Add lines 3(b) and 4(b), column (c). Enter the total here and on Form 720 on the line forIRS No. 18 . . .
7 Imported petroleum products superfund tax. Enter the number of barrels imported in column (a). (Must agree with line 8, column (a).) Enter in column (c) the amount of tax by multiplying column (a) by column (b), and also enter it on Form 720 on the line forIRS No. 16 . . . . . . .	7 Imported petroleum products superfund tax. Enter the number of barrels imported in column (a). (Must agree with line 8, column (a).) Enter in column (c) the amount of tax by multiplying column (a) by column (b), and also enter it on Form 720 on the line forIRS No. 16 . . . . . . .	7 Imported petroleum products superfund tax. Enter the number of barrels imported in column (a). (Must agree with line 8, column (a).) Enter in column (c) the amount of tax by multiplying column (a) by column (b), and also enter it on Form 720 on the line forIRS No. 16 . . . . . . .		$ .18 bbl	$ .18 bbl	$
8 Imported petroleum products oil spill tax. Enter the number of barrels imported in column (a). (Must agree with line 7, column (a).) Multiply column (a) by column (b) and enter the amount of tax in column (c). Also enter the amount on Form 720 on the line forIRS No. 21 . . . . .

Chemical (general formula or symbol)	(a) Tons	(b) Rate	(c) Tax (multiply column (a) by column (b))		Chemical (general formula or symbol)	(a) Tons	(b) Rate	(c) Tax (multiply column (a) by column (b))
1 Acetylene (C2H2)		$9.74			24 Lead oxide (PbO)		$8.28
2 Ammonia (NH3) .		5.28			25 Mercury (Hg) . .		8.90
3 Antimony (Sb) .		8.90			26 Methane (CH4) .		6.88
4 Antimony trioxide (Sb2O3) . . .		7.50			27 Naphthalene (C10H8)		9.74
4 Antimony trioxide (Sb2O3) . . .		7.50			28 Nickel (Ni) . . .		8.90
5 Arsenic (As) . .		8.90			29 Nitric acid (HNO3)		0.48
6 Arsenic trioxide (As2O3) . . . .		6.82			30 Phosphorus (P) .		8.90
6 Arsenic trioxide (As2O3) . . . .		6.82			31 Potassium dichromate (K2Cr2O7)		3.38
7 Barium sulfide (BaS)		4.60
8 Benzene (C6H6) .		9.74			32Potassium hydroxide (KOH) .		0.44
9 Bromine (Br) . .		8.90
10 Butadiene (C4H6)		9.74			33 Propylene (C3H6) .		9.74
11 Butane (C4H10) .		9.74			34Sodium dichromate (NaCr2O7) . . .		3.74
12 Butylene (C4H8) .		9.74
13 Cadmium (Cd) .		8.90			35Sodium hydroxide (NaOH) . . . .		0.56
14 Chlorine (Cl) . .		5.40
15 Chromite (FeCr2O4)		3.04			36Stannic chloride (SnCl4) . . . .		4.24
16 Chromium (Cr) .		8.90
17 Cobalt (Co) . .		8.90			37Stannous chloride (SnCl2) . . . .		5.70
18 Cupric oxide (CuO)		7.18
19 Cupric sulfate (CuSO4)		3.74			38 Sulfuric acid (H2SO4)		0.52
20 Cuprous oxide (Cu2O)		7.94			39 Toluene (C7H8) .		9.74
21 Ethylene (C2H4) .		9.74			40 Xylene (C8H10) .		9.74
22 Hydrochloric acid (HCI)		0.58			41 Zinc chloride (ZnCl2)		4.44
23 Hydrogen fluoride (HF)		8.46			42 Zinc sulfate (ZnSO4)		3.80
43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	43 Total Chemical Tax (add lines 1–42, column (c)). Enter here and on Form 720 on the line forIRS No. 54	$

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 720. Cat. No. 43490I Form 6627 (Rev. 1-2026) Created 11/26/25

Form 6627 (Rev. 1-2026) Page 2

Part III Tax on Imported Chemical Substances, IRS No. 17¶

(a) Imported chemical substance	(b) Tons	(c) Taxable chemical used in manufacture of substance	(d) Conversion factor or entry value	(e) Rate	(f) Tax (see instructions)
1
1
2
2
3
3
4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any additional sheets. Enter here and on Form 720 on the line forIRS No. 17 . . . . . . . . . .	4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any additional sheets. Enter here and on Form 720 on the line forIRS No. 17 . . . . . . . . . .	4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any additional sheets. Enter here and on Form 720 on the line forIRS No. 17 . . . . . . . . . .	4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any additional sheets. Enter here and on Form 720 on the line forIRS No. 17 . . . . . . . . . .	4 Total imported chemical substances tax. Add all amounts in column (f). Include amounts from any additional sheets. Enter here and on Form 720 on the line forIRS No. 17 . . . . . . . . . .	$

Exceptions & meaning →

Part IV Tax on Ozone-Depleting Chemicals (ODCs), IRS No. 98¶

Elections. If you elect to report the tax on post-1989 ODCs at the time you sell or use a mixture containing such chemicals instead of when you make the mixture, check this box (the 1990 election) . . . . . . . . . . . . . . . . . . If you elect to report the tax on post-1990 ODCs at the time you sell or use a mixture containing such chemicals instead of when

Election. If you elect to report the tax on imported products at the time you import the products instead of when you sell or use
the products, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(a) Imported product and the applicable ODC	(b) Number of products	(c) ODC weight of product	(d) Tax per pound	(e) Entry value	(f) Tax (see Part V instructions)	(f) Tax (see Part V instructions)
1
2
3
4 Total ODC tax on imported products.Add all amounts in column (f). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 19. . . . . . .	4 Total ODC tax on imported products.Add all amounts in column (f). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 19. . . . . . .	4 Total ODC tax on imported products.Add all amounts in column (f). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 19. . . . . . .	4 Total ODC tax on imported products.Add all amounts in column (f). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 19. . . . . . .	4 Total ODC tax on imported products.Add all amounts in column (f). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 19. . . . . . .	$	$

Part VI Tax on Floor Stocks of ODCs, IRS No. 20

(a) ODC	(b) Number of pounds	(c) Tax per pound (see Part VI instructions)	(d) Tax (multiply column (b) by column (c))
1
2
3
4 Total floor stocks tax.Add all amounts in column (d). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 20. . . . . . . . . . . . .	4 Total floor stocks tax.Add all amounts in column (d). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 20. . . . . . . . . . . . .	4 Total floor stocks tax.Add all amounts in column (d). Include amounts from any additional sheets. Enter the total here and on Form 720 on the line forIRS No. 20. . . . . . . . . . . . .	$

Form 6627 (Rev. 1-2026)

Exceptions & meaning →