Fillable Form 8849 (Schedule 3) (Rev. December 2012) printable pdf download

Certain Fuel Mixtures

Schedule 3

(Form 8849)

and the Alternative Fuel Credit

OMB No. 1545-1420

(Rev. December 2012)

Attach to Form 8849. Do not file with any other schedule.

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Department of the Treasury

Information about Schedule 3 (Form 8849) and its instructions is at

Internal Revenue Service

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Name as shown on Form 8849

EIN or SSN

Total refund (see instructions)

Caution. The biodiesel mixture credit and renewable diesel mixture credit must first be taken as a credit against your taxable fuel liability

(gasoline, diesel fuel, and kerosene) reported on Form 720. Similarly, the alternative fuel credit must first be taken on Form 720 as a credit

against your alternative fuel or compressed natural gas (CNG) tax liability. If you have these tax liabilities and you did not make the claim on

Schedule C (Form 720) as a credit against those liabilities, you must first file Form 720X, Amended Quarterly Federal Excise Tax Return, before

Form 8849, Schedule 3, can be used for the refund. You cannot claim any amounts on Form 8849 that you claimed (or will claim) on Schedule

C (Form 720), Form 720X, or Form 4136, Credit for Federal Tax Paid on Fuels.

The alternative fuel mixture credit cannot be claimed on this form or on Form 4136. It must be taken as a credit against your taxable fuel

liability (gasoline, diesel fuel, and kerosene) reported on Form 720.

Claimant’s registration no.

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Enter your registration number, including the prefix. Line 3 claimants must enter their AL or AM registration number.

Period of claim: Enter month, day, and year in

MMDDYYYY format.

From

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Reserved

(a)

(b)

(d)

Rate

Gallons of alcohol

CRN

Multiply col. (a) by col. (b).

Reserved

Biodiesel or Renewable Diesel Mixture Credit

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM D6751 and met EPA’s

registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant

has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing

renewable diesel with liquid fuel (other than renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass, met EPA’s

registration requirements for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. The mixture was sold by the claimant

to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller,

both of which have been edited as discussed in the instructions for line 2. See the instructions for line 2 for information about renewable diesel used in aviation.

(b)

(a)

Gallons of

(d)

Rate

biodiesel or

Multiply col. (a) by col. (b)

CRN

renewable diesel

a Biodiesel (other than agri-biodiesel) mixtures

$1.00

388

b Agri-biodiesel mixtures

1.00

390

c Renewable diesel mixtures

1.00

307

Alternative Fuel Credit

(b)

(a)

(d)

Gallons or

Rate

CRN

Multiply col. (a) by col. (b)

gasoline gallon

equivalents (GGE)

a Liquefied petroleum gas (LPG)

$.50

426

b “P” Series fuels

.50

427

c Compressed natural gas (CNG) (GGE = 121 cu. ft.)

.50

428

d Liquefied hydrogen

.50

429

e Fischer-Tropsch process liquid fuel from coal (including peat)

.50

430

Liquid fuel derived from biomass

.50

431

g Liquefied natural gas (LNG)

.50

432

h Liquefied gas derived from biomass

.50

436

Compressed gas derived from biomass (GGE = 121 cu. ft.)

.50

437

Send this schedule with completed Form 8849 to: Internal Revenue Service, P.O. Box 312, Covington, KY 41012-0312; on the envelope write “Fuel Mixture Claim.”

For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions.

Cat. No. 27451F

Schedule 3 (Form 8849) (Rev. 12-2012)