Form 4136n Nebraska Nonhighway Use Motor Vehicle Fuels Credit
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1
2NEBRASKA NONHIGHWAY USE MOTOR VEHICLE FUELS CREDIT COMPUTATION
FORM 4136N
for use with Form 1040N, Form 1041N, Form 1065N, Form 1120N, and Form 1120-SN
2000
nebraska
department
• Read instructions on reverse side
of revenue
Name as Shown on Return
Social Security or Nebraska I.D. Number
Nebraska Nonhighway Use I.D. Number
88–
PART A — Nonhighway Use Motor Vehicle Fuels Credit Computation
1 Gallons of gasoline and gasohol purchased directly from sellers. Enter in the space provided the seller's name and the number of
gallons purchased from each seller during each period. Retain all invoices with your records.
NUMBER OF GALLONS PURCHASED
Name of Seller
(A)
(B)
(Attach Schedule, if Necessary)
1-1-2000
7-1-2000
Through 6-30-2000
Through 12-31-2000
TOTAL GALLONS PURCHASED
1
2 Distributed share of gallons purchased during each period by a partnership, limited liability
company, or S corporation (see instructions on reverse side) . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Total gallons qualified for credit (total of lines 1 and 2, column A) . . . . . . . . . . . . . . . . . . . . .
3
4 Total gallons qualified for credit (total of lines 1 and 2, column B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5 Nonhighway use motor vehicle fuels credit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.2165
.2165
$
$
6 Nonhighway use motor vehicle fuels credit for each period (lines 3 and 4 multiplied by line 5)
6
7 Total Form 4136N credit (total of line 6, columns A and B). Enter here and on appropriate line of
$
Forms 1040N, 1041N, or 1120N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
PART B — For Partners, Limited Liability Company Members, and S Corporation Shareholders Only
8 If any of the gallons in Part A are a share of gallons purchased by a partnership, limited liability company, or an S corporation, enter in
the space provided the name, address, Nebraska identification number, and federal identification number of each partnership, limited
liability company, or S corporation.
Name
Address
Nebraska I.D. Number Federal I.D. Number
PART C — For Partnerships, Limited Liability Companies, and S Corporations Only
9 Distribution of qualified gallons among partners, members, and shareholders. Enter in the space provided the partner’s, member’s, or
shareholder’s name, social security number or federal identification number, share of income/ownership, and share of gallons purchased
during each period.
SHARE OF GALLONS
Social Security
Share of
1-1-2000
7-1-2000
Number or Federal
Income or
Names of Partners, Members, or Shareholders
Through
Through
I.D. Number
Ownership
6-30-2000
12-31-2000
TOTALS
100%
8-419-2000
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