Form Ia 4136 - Computation Of Iowa Motor Fuel Tax Credit - 2000
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1I OWA
2000 IA 4136
d e p a r t m e nt o f R e ve n ue a n d F i n a nc e
Computation of Iowa Motor Fuel Tax Credit
Taxable Year Ended __________ , 2000
Attach this form to your Iowa income tax
return. See reverse side for instructions
Name(s) as shown on page 1 of the IA1040
Social Security No.
FUEL USED FOR: (Please check the appropriate box)
s
1) Farming
2) Commercial
3) Commercial Fishing
4) Other (specify) _____________________________
Fuel Type
Gasoline
Gasohol
Undyed Diesel Fuel Special Fuel (LPG)
A
B
C
D
Iowa Fuel Tax Rate Per Gallon
20¢
19¢
22.5¢
20¢
Credit Computation
1. Number of gallons
from original invoices ...........................
2. Gallons used on highway ....................
3. Gallons claimed
s
s
s
s
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
s
s
s
s
(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 D .................................................................................................................... $
THE FOLLOWING REQUIREMENTS MUST BE MET FOR THIS CLAIM TO BE HONORED:
PLEASE
Attach a
copy of
federal 4136
41-005a (6/16/00)
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