Form 4136 - Credit For Federal Tax Paid On Fuels
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44136
OMB No. 1545-0162
Credit for Federal Tax Paid on Fuels
2004
Form
See the Instructions on page 3.
Attachment
Department of the Treasury
23
Attach this form to your income tax return.
Sequence No.
Internal Revenue Service
Name (as shown on your income tax return)
Taxpayer identification number
Caution: ● You cannot claim any amounts on Form 4136 that you claimed on Form 8849 or Schedule C (Form 720).
● Sales by gasoline wholesale distributors cannot be claimed on Form 4136. Instead, use Schedule 4 (Form 8849)
or Schedule C, line 11 (Form 720) to make these claims.
Nontaxable Use of Gasoline and Gasohol
1
(b)
(c)
(d)
(a) Type
(e)
of use
Rate
Gallons
Amount of credit
CRN
$
a
Off-highway business use of gasoline
$
.184
362
b
Use of gasoline on a farm for farming purposes
.184
.184
c
Other nontaxable use of gasoline
.184
$
359
d
10% gasohol
.132
375
e
7.7% gasohol
.14396
376
f
5.7% gasohol
.15436
2
Nontaxable Use of Aviation Gasoline
(b)
(c)
(d)
(e)
(a) Type
of use
Rate
Gallons
Amount of credit
CRN
$
354
a
Use in commercial aviation (other than foreign trade)
$
.15
.194
b
324
Other nontaxable use
.194
3
Nontaxable Use of Undyed Diesel Fuel
Claimant has the name and address of the person(s) who sold the diesel fuel to the claimant and the date(s) of the purchase(s) and if
exported, the required proof of export.
Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and
check here
Caution: Claims cannot be made on line 3 for diesel fuel used
(b)
(c)
(d)
(e)
(a) Type
on a farm for farming purposes. Only registered ultimate
of use
Rate
Gallons
Amount of credit
CRN
vendors may make those claims (see line 6).
$
$
.244
360
a
Nontaxable use
.244
353
b
Use in trains
.20
350
c
Use in certain intercity and local buses
.17
4
Nontaxable Use of Undyed Kerosene
Claimant has the name and address of the person(s) who sold the kerosene to the claimant and the date(s) of the purchase(s) and if
exported, the required proof of export.
Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach a detailed explanation and check
here
Caution: Claims cannot be made on line 4 for kerosene used
on a farm for farming purposes or for kerosene sold from a
(b)
(c)
(d)
(e)
(a) Type
of use
blocked pump. Only registered ultimate vendors may make
Rate
Gallons
Amount of credit
CRN
those claims (see line 7).
$
$
.244
346
Nontaxable use
.244
4136
For Paperwork Reduction Act Notice, see the instructions.
Cat. No. 12625R
Form
(2004)
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