Note: This example is for educational purposes only and should not be considered as legal or financial advice. Below is an example of a completed IRS Form 2290 with fictional data:

FORM 2290 (Rev. July 2022)
Department of the Treasury
Internal Revenue Service

Heavy Highway Vehicle Use Tax Return

Part I: Identification

• Employer Identification Number (EIN): 12-3456789
• Name: John Doe Trucking Inc.
• Address: 123 Main St.
• City: Springfield
• State: IL
• ZIP Code: 62704
• Check if applicable:
  • [X] Address change
  • [ ] Name change
  • [ ] Final return
• Check if applicable:
  • [ ] Amended return
  • [ ] VIN correction
  • [ ] Suspended vehicles exceed limit

Part II: Tax Computation

• Taxable Vehicles (number): 5
• Taxable gross weight category: 75,000 lbs. or more
• Tax for the period (see instructions): $550.00
• Additional tax from increase in taxable gross weight (see instructions): $0.00
• Total tax (line 11 + line 12): $2,750.00
• Total tax due (line 13 minus credits claimed on Schedule 1): $2,750.00
• Balance due (amount you owe): $2,750.00
• Third Party Designee
• Designee's name: Jane Smith
  • Phone: (555) 123-4567
  • PIN: 1234

Part III: Consent to Disclosure

• Consent to disclosure: [X] Yes [ ] No

Part IV: Declaration

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 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: John Doe
• Title: President
• Date: 08/01/2022
• Paid preparer's name: Jane Smith
• Paid preparer's phone: (555) 123-4567
• Paid preparer's PTIN: P01234567
• Paid preparer's signature: Jane Smith
• Date: 08/01/2022