Instructions For Form 4136 - Credit For Federal Tax Paid On Fuels

nontaxable use in noncommercial aviation (foreign trade

Line 13. Registered Credit Card Issuers

for line 8f) is eligible to make this claim only if the buyer

Claimant. The registered credit card issuer is the only

waives his or her right to make the claim by providing the

person eligible to make this claim if the credit card issuer:

registered ultimate vendor with an unexpired waiver. See

Is registered by the IRS;

Model Waiver L in Pub. 510. For type of use 14, see

Hasn’t collected the amount of tax from the ultimate

Model Certificate P in Pub. 510. Only one claim may be

purchaser or has obtained the written consent of the

filed for any gallon of kerosene sold for use in

ultimate purchaser to make the claim;

noncommercial aviation.

Certifies that it has repaid or agreed to repay the

Allowable sales. For line 8c, the kerosene must have

amount of tax to the ultimate vendor, has obtained the

been sold for a nonexempt use in noncommercial

written consent of the ultimate vendor to make the claim,

aviation. For lines 8d and 8e, the kerosene sold for use in

or has otherwise made arrangements which directly or

noncommercial aviation must have been sold during the

indirectly provide the ultimate vendor with reimbursement

period of claim for type of use 1, 9, 10, 11, 13, 14, 15, or

of the tax; and

16.

Has in its possession an unexpired certificate from the

For line 8f, the kerosene sold for use in noncommercial

ultimate purchaser and has no reason to believe any of

aviation must have been sold during the period of claim

the information in the certificate is false. See Model

for type of use 9. This claim is made in addition to the

Certificate R in Pub. 510.

claim made on lines 8d and 8e for type of use 9.

If any of these conditions isn’t met, the credit card

issuer must collect the tax from the ultimate purchaser

Registration number. Enter your UA (UV if type of use

and only the ultimate purchaser can make the claim.

14) registration number in the space provided.

Allowable sales. The diesel fuel, kerosene, or kerosene

Line 9

for use in aviation must have been purchased with a credit

card issued to the ultimate purchaser during the period of

Line 9 is reserved for future use.

claim for the exclusive use by a state or local government

(including essential government use by an Indian tribal

Line 10

government).

Line 10 is reserved for future use.

Registration number. Enter your CC registration

number in the space provided.

Line 11. Nontaxable Use of Alternative Fuel

For line 13c, if the kerosene was taxed at $.244,

Claimant. The ultimate purchaser of the taxed alternative

the claim rate is $.243. Write “Taxed at $.244” in

fuel is the only person eligible to make this claim.

the space to the left of column (b). Enter $.243 in

CAUTION

column (b).

Allowable uses. The alternative fuel must have been

used during the period of claim for type of use 1, 2, 4, 5, 6,

7, 11, 13, 14, or 15.

Line 14. Nontaxable Use of a Diesel-Water Fuel

Type of use 5. Write “Bus” in the space to the left of

Emulsion

column (a). Enter the correct claim rate in column (b). The

claim rates for type of use 5 are listed below.

Claimant. The ultimate purchaser of the diesel-water fuel

emulsion is the only person eligible to make this claim.

Line number

Claim rate

Allowable uses. For line 14a, the diesel-water fuel

emulsion must have been used during the period of claim

11a

$.109*

for type of use 1, 2, 5, 6, 7, 8, 11, 13, 14, or 15. For

11b

.110

line 14b, the diesel-water fuel emulsion must have been

11c

.109**

exported during the period of claim (type of use 3). See

11d

.110

Exported taxable

fuel, earlier.

Type of use 5. Write “Bus” in the space to the left of

11e

.17

column (a). Enter the correct claim rate in column (b). The

11f

.17

claim rate for type of use 5 is $.124 per gallon.

11g

.169***

11h

.110

Line 15. Diesel-Water Fuel Emulsion Blending

For sales or uses of fuel after December 31, 2015: (*) This is the claim rate per

Claimant. The person that produced (the blender) and

GGE (5.75 pounds or 1.353 gallons of LPG); (**) This is the claim rate per GGE

(5.66 pounds or 123.57 cubic ft. of CNG); (***) This is the claim rate per DGE (6.06

sold or used the diesel-water fuel emulsion is the only

pounds or 1.71 gallons of LNG)

person eligible to make this claim.

Registration number. Enter your M registration number

in the space provided.

Type of use 5 example. 10,000 gallons of LPG ÷ 1.353

= 7,391 GGE x $0.109 = $805.62 claim amount.

Information to be submitted. The blender must attach

a statement to the claim certifying that:

Line 12

The diesel-water fuel emulsion contains at least 14%

water,

Line 12 is reserved for future use.

-5-

Instructions for Form 4136 (2017)

Instructions For Form 4136 - Credit For Federal Tax Paid On Fuels - 2017 Page 5

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