Form 4136 - Credit For Federal Tax Paid On Fuels Page 2
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Form 4136 (2004)
Page
5
Nontaxable Use of Aviation Fuel
(a) Type
(b)
(c)
(d)
(e)
of use
Rate
Gallons
Amount of credit
CRN
$
355
a
Use in commercial aviation (other than foreign trade)
$
.175
b
369
Other nontaxable use
.219
.044
377
c
Other nontaxable uses
6
Sales by Registered Ultimate Vendors of Undyed Diesel Fuel
UV Registration No.
Claimant sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the
buyer to take the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the
certificate is false. See the instructions for additional information to be submitted.
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
(b)
(c)
(d)
(e)
(a) Type
of use
Rate
Gallons
Amount of credit
CRN
$
a
Use on a farm for farming purposes
$
.244
360
b
Use by a state or local government
.244
UV Registration No.
7
Sales by Registered Ultimate Vendors of Undyed Kerosene
UP Registration No.
Claimant sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer
to take the claim; and obtained the required certificate (for lines 7a and 7b) from the buyer and has no reason to believe any information
in the certificate is false, or has the Regulations section 48.6427-10(e)(4) statement, if required, for line 7c. See the instructions for
additional information to be submitted.
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
(b)
(c)
(d)
(e)
(a) Type
of use
Rate
Gallons
Amount of credit
CRN
$
a
Use on a farm for farming purposes
$
.244
346
b
Use by a state or local government
.244
c
Sales from a blocked pump
.244
8
Nontaxable Use of Liquefied Petroleum Gas (LPG) in Certain Buses
(b)
(c)
(d)
(e)
(a) Type
of use
Rate
Gallons
Amount of credit
CRN
$
352
a
Use in certain intercity and local buses
$
.062
361
b
Use in qualified local buses or school buses
.136
9
Gasohol Blending
Claimant bought gasoline taxed at the full rate and blended it with alcohol to make gasohol. The gasohol was sold or used in
claimant’s trade or business. For each batch of gasohol, claimant has the required information relating to the purchase of the
gasoline and alcohol used to make the gasohol and to support the amount claimed.
Gallons of
(d)
(a)
(e)
Amount of credit
(b)
(c)
Rate
CRN
(col. (a)
col. (b))
Gasoline
Alcohol
$
356
a
10% gasohol
$
.03734
357
b
7.7% gasohol
.02804
363
c
5.7% gasohol
.02031
Total income tax credit claimed. Add lines 1 through 9, column (d). Enter here and on
10
Form 1040, line 69 (also check box b on line 69); Form 1120, line 32g; Form 1120-A, line
28g; Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns.
10
$
4136
Form
(2004)
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