Form Ia 4136 - Fuel Tax Credit For Fiscal Year Filers 2014 Iowa

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Iowa Department of Revenue
2014 IA 4 136
https://tax.iowa.gov/
Iowa Fuel Tax Credit for Fiscal Year Filers
Name(s)
SSN or FEIN
Check appropriate box(es):
Fuel used for:
1) Farming
2) Commercial
3) Commercial Fishing
4) Other
(specify)
1. Gasoline
Invoice
Invoice
Highway
Claimed
Tax
Fuel Tax
Sales
Fuel Tax
Date
Gallons
Gallons
Gallons
Rate
Paid
Tax
Credit
01/01/2014
to
1a.
$0.21
$
$
$
02/28/2015
03/01/2015
to
1b.
$0.31
$
$
$
06/30/2015
07/01/2015
to
1c.
$0.308
$
$
$
11/30/2015
2. Gasohol
Invoice
Highway
Claimed
Tax
Fuel Tax
Sales
Fuel Tax
Invoice
Gallons
Gallons
Gallons
Rate
Paid
Tax
Credit
Date
01/01/2014
to
2a.
$0.19
$
$
$
02/28/2015
03/01/2015
to
2b.
$0.29
$
$
$
06/30/2015
07/01/2015
to
2c.
$0.293
$
$
$
11/30/2015
3. E85
Invoice
Invoice
Highway
Claimed
Tax
Fuel Tax
Sales
Fuel Tax
Date
Gallons
Gallons
Gallons
Rate
Paid
Tax
Credit
01/01/2014
3a.
to
$0.19
$
$
$
02/28/2015
03/01/2015
to
3b.
$0.29
$
$
$
06/30/2015
07/01/2015
to
3c.
$0.293
$
$
$
11/30/2015
*1541005019999*
41-036a (03/04/15)

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