Form Ia 4136 - Computation Of Iowa Motor Fuel Tax Credit

Iowa Department of Revenue

2006 IA 4136

Computation of Iowa Motor Fuel Tax Credit

For calendar year 2006 or Fiscal Year Ended _____________________ , 20 ______

Attach this form to your Iowa income tax return. See reverse side for instructions

Name(s) as shown on page 1 of the IA1040, 1120, 1120A, or 1041

Social Security No. or FEIN

FUEL USED FOR: (Please check the appropriate box)

1) Farming

2) Commercial

3) Commercial Fishing

4) Other (specify)

A - Gasoline

B - Gasoline

Fuel Type

(1/1/06-6/30/06)

(7/1/06-12/31/06)

Gasohol

E85

Undyed Diesel Fuel

Special Fuel (LPG)

Iowa Fuel Tax Rate Per Gallon

20.7¢

21.0¢

19¢

17¢

22.5¢

20¢

Credit Computation

1. Number of gallons from original invoices

2. Gallons used on highway

3. Gallons claimed

Subtract line 2 from line 1

4. Credit: Multiply line 3 by the fuel tax

rate shown above

5. Less Sales Tax: Non-farm use only

(see instructions on reverse side)

6. Net Amount of Credit

Subtract line 5 from line 4

7. Total Credit

Add line 6, columns A through F

THE FOLLOWING REQUIREMENTS MUST BE MET

8. Fuel used in motor vehicles for off-loading procedures

FOR THIS CLAIM TO BE HONORED:

does not qualify for the credit. See instructions for

additional information.

PLEASE

1. You made no claims for a fuel tax refund on fuel purchased during this tax year.

9. Sales tax (nonfarm usage) must be computed correctly.

2. You do not have an active motor fuel tax refund permit for this tax year.

See instructions for additional information.

Attach a

3. All information requested on this form must be accurately entered.

10. Invoices showing gallons must be issued in the name of

4. You must have and maintain records verifying nonhighway gallons purchased.

copy of

the individual, estate, trust or corporation claiming the

5. All gallons claimed for credit were paid for in the tax period.

credit. See instructions for partners or S corporation

federal 4136

6. The gallons claimed were or will be consumed in other than a registered vehicle.

shareholders.

7. Gasoline used in a boat does not qualify for credit unless the boat was used for

11. A copy of the federal 4136 must also be attached to your

commercial fishing.

Iowa Income Tax Return.

41-005a (10/4/06)

Form Ia 4136 - Computation Of Iowa Motor Fuel Tax Credit - 2006

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