8821 Tax Information Authorization

U.S. Individual Income Tax Return

8821

U.S. Individual Income Tax Return

OMB: 1545-0074

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Form

4136

OMB No. 1545-0162

Credit for Federal Tax Paid on Fuels
©

Department of the Treasury
Internal Revenue Service

2006

See the separate instructions.

Attachment
Sequence No.

Attach this form to your income tax return.

Name (as shown on your income tax return)

Taxpayer identification number

Caution. Claimant has the name and address of the person who sold the fuel to the claimant and the dates of purchase.
For claims on lines 1c and 2b (type of use 13 and 14), 3d, 4c, and 5, claimant has not waived the right to make
the claim. For claims on lines 1c and 2b (type of use 13 and 14), claimant certifies that a certificate has not
been provided to the credit card issuer.
1

Nontaxable Use of Gasoline
(a) Type of use

a
b
c
d
2

Off-highway business use

$ .183

Use on a farm for farming purposes

.183

Other nontaxable use (see Caution above line 1)

.183

Exported

.184

(d) Amount of credit (e) CRN
$
362
411

Nontaxable Use of Aviation Gasoline
(a) Type of use

a Use in commercial aviation (other than foreign trade)
b Other nontaxable use (see Caution above line 1)
c Exported
3

(b) Rate

(d) Amount of credit (e) CRN
$
354
324

$ .15
.193

412

.194

Nontaxable Use of Undyed Diesel Fuel

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 an explanation and check here ©
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Nontaxable use
$
$ .243
360
.243
b Use on a farm for farming purposes
.22
c Use in trains
353

d Use in certain intercity and local buses (see Caution
above line 1)
Exported
e

.17

350

.244

413

Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)
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 an explanation and check here ©
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN

a Nontaxable use
b Use on a farm for farming purposes

$ .243
.243

346

c Use in certain intercity and local buses (see Caution
above line 1)

d Exported
5

.17

347

.244

414

Kerosene Used in Commercial Aviation (Other Than Foreign Trade)
(b) Rate

a Kerosene taxed at $.244 (see Caution above line 1)
b Kerosene taxed at $.219 (see Caution above line 1)
For Paperwork Reduction Act Notice, see the separate instructions.

$ .200

(d) Amount of credit (e) CRN
417

355

.175
Cat. No. 12625R

Form

4136

(2006)

Form 4136 (2006)

Page

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Registration No.

Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written
consent of the buyer to make the claim. 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 an explanation and check here
(b) Rate

a Use by a state or local government
b Use in certain intercity and local buses

Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Kerosene For Use in Aviation)

$ .243

360
350

.17

Registration No.

(d) Amount of credit (e) CRN

Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent
of the buyer to make the claim. 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 an explanation and check here
(b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
$
a Use by a state or local government
$ .243
346
b Sales from a blocked pump
.243

c Use in certain intercity and local buses

Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

.17

Registration No.

347

Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer, repaid
the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. See the instructions for additional
information to be submitted.
(a) Type of use (b) Rate
(c) Gallons
(d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade)
$
taxed at $.219
355
$ .175

b Use in commercial aviation (other than foreign trade)
taxed at $.244

c Nonexempt use in noncommercial aviation
d Other nontaxable uses taxed at $.244
e Other nontaxable uses taxed at $.219

Reserved for future use

.200

417

.025

418
346

.243
.218

369

Form

4136

(2006)

Form 4136 (2006)

Page

Nontaxable Use of Liquefied Petroleum Gas (LPG) (before October 1, 2006)
(a) Type of use

a Use in certain intercity and local buses
b Use in qualified local buses or school buses
c Other nontaxable use
12

(b) Rate

$ .062
.136

(d) Amount of credit (e) CRN
$
352
361
395

.136

Alcohol Fuel Mixture Credit

Registration No.

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any
person for use as a fuel or was used as a fuel by the claimant.
(b) Rate

a Alcohol fuel mixtures containing ethanol
b Alcohol fuel mixtures containing alcohol (other than ethanol)
13

(d) Amount of credit (e) CRN
393
394

$ .51
.60

Biodiesel or Renewable Diesel Mixture Credit

Registration No.

Claimant produced a mixture by mixing diesel fuel with biodiesel or renewable diesel. The biodiesel used to produce the biodiesel mixture
must meet ASTM D6751 and be registered with the EPA as a fuel and fuel additive under section 211 of the Clean Air Act. The mixture was
sold by the claimant to any person for use as fuel or was used as a fuel by the claimant. Claimant has a certificate from the producer or
importer of the biodiesel which identifies the percentage of biodiesel and agri-biodiesel in the product, and has no reason to believe the
information is false. See the instructions for line 13 to see if you must attach the certificate.
(b) Rate

a Biodiesel (other than agri-biodiesel) mixtures
b Agri-biodiesel mixtures
c Renewable diesel mixtures
14

(d) Amount of credit (e) CRN

388

$ .50

390

1.00
1.00

307

Nontaxable Use of Alternative Fuel (after September 30, 2006)
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 4 in the Instructions for Form 4136 for the credit rate.
(c) Gallons
(a) Type of use
(b) Rate
(d) Amount of credit (e) CRN
or gasoline
gallon
equivalents (GGE)
$
Liquefied petroleum gas (LPG)
$ .183
419
.183
420
“P Series” fuels
.183
Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)
421
Liquefied hydrogen
.183
422

a
b
c
d
e Any liquid fuel derived from coal (including peat) through
the Fischer-Tropsch process

f Liquid hydrocarbons derived from biomass
g Liquefied natural gas (LNG)

Alternative Fuel Credit and Alternative Fuel Mixture Credit (after
September 30, 2006)

Registration No.
(b) Rate

a
b
c
d
e

Liquefied petroleum gas (LPG)

$ .50

“P Series” fuels
Compressed natural gas (CNG) (GGE = 121 cu. ft.)

.50

Liquefied hydrogen
Any liquid fuel derived from coal (including peat) through the
Fischer-Tropsch process

.50

f Liquid hydrocarbons derived from biomass
g Liquefied natural gas (LNG)

423
424
425

.243
.243
.243

(d) Amount of credit (e) CRN

426
427
428
429

.50

430
431

.50

432

.50
Form

4136

(2006)

Form 4136 (2006)

Page

Registration No.

Registered Credit Card Issuers

a Diesel fuel sold for the exclusive use of a state or local government
b Kerosene sold for the exclusive use of a state or local government
c Kerosene for use in aviation sold for the exclusive use of a state or local

(d) Amount of credit (e) CRN
$
360
346

.218

government

(b) Rate
$ .243
.243

369

Nontaxable Use of a Diesel-Water Fuel Emulsion
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 4 in the Instructions for Form 4136 for the credit rate.
(a) Type of use

a Nontaxable use
b Exported

(b) Rate
.198

(b) Rate

$ .046

(d) Amount of credit (e) CRN
$
310

Exported Dyed Fuels
(b) Rate

a Exported dyed diesel fuel
b Exported dyed kerosene
20

(d) Amount of credit (e) CRN
$
309
306

Registration No.

Diesel-Water Fuel Emulsion Blending

Blender credit

$ .197

$ .001

(d) Amount of credit (e) CRN
415
416

.001

Total income tax credit claimed. Add lines 1 through 19, column (d). Enter here and on
Form 1040, line 70 (also check box b on line 70); Form 1120, line 32f(2); Form 1120-A, line
28f(2); Form 1120S, line 23c; Form 1041, line 24h; or the proper line of other returns. ©

20 $
Form

4136

(2006)

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Instructions for Form 4136

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2006

Department of the Treasury
Internal Revenue Service

Instructions for Form 4136
Section references are to the Internal Revenue Code unless
otherwise noted.

What’s New
The changes shown below were made under the Energy Policy
Act of 2005; the Safe, Accountable, Flexible, and Efficient
Transportation Equity Act of 2005; and the Pension Protection
Act of 2006.
Exported taxable fuel. A credit for exported taxable fuel can
be claimed on lines 1d, 2c, 3e, 4d, 19a, and 19b as applicable.
Line 5. The credit for nontaxable use of aviation-grade
kerosene has been replaced, after September 30, 2005, with a
credit for kerosene used in commercial aviation (other than for
foreign trade). This credit was claimed on line 14a in 2005.
Line 8. The credit for sales by registered ultimate vendors of
aviation-grade kerosene has been replaced, after September
30, 2005, with a credit for sales by registered ultimate vendors
of kerosene for use in aviation. This credit was claimed on line
14b in 2005.
Qualified blood collector organizations. After December 31,
2006, qualified blood collector organizations are exempt users
of fuel taxed under section 4081. Type of use 11, Exclusive use
by a qualified blood collector organization, has been added to
the Type of Use Table on page 2. Two conditions must be met
to apply for the credit on Form 4136.
1. The fuel is used for the organizations’s exclusive use in
the collection, storage, or transportation of blood.
2. The organization is registered by the IRS. To apply for
registration, see Form 637, Application for Registration (For
Certain Excise Tax Activities). See How To Get Forms and
Publications in the instructions for your income tax return.
Registered credit card issuers. Claims for sales of certain
taxable fuel to state and local governments can be made by
registered credit card issuers if certain conditions are met. See
Line 16. Registered Credit Card Issuers for more information.
Registered credit card issuers and registered ultimate
vendors. You cannot make a claim on Form 4136 for gasoline
and aviation gasoline sold to a state or local government or a
nonprofit educational organization. Instead, these claims must
be made on Schedule C (Form 720) or the appropriate
schedule of Form 8849.
Type of use table. The Type of Use Table on page 2 has been
revised. Some uses listed in the table are not applicable to
Form 4136. See the specific line instructions for the allowable
uses.
Undyed diesel fuel and undyed kerosene for farming
purposes. Ultimate purchasers use lines 3b and 4b to make
these claims. Registered ultimate vendor refund claims for
undyed diesel fuel and undyed kerosene (other than kerosene
for use in aviation) sold for use on a farm for farming purposes
have been eliminated.
New lines. The following new lines have been added.
• Line 13c for renewable diesel mixtures.
• Line 14 for nontaxable use of alternative fuel (after
September 30, 2006).
• Line 15 for alternative fuel credit and alternative fuel mixture
credit (after September 30, 2006).
• Line 16 for registered credit card issuers.
• Line 17 for nontaxable use of a diesel-water fuel emulsion.
• Line 18 for diesel-water fuel emulsion blending.

General Instructions
Purpose of Form
Use Form 4136 to claim a credit for certain nontaxable uses (or
sales) of fuel during the income tax year. Also use Form 4136 if

you are claiming the alternative fuel credit, a blender claiming a
credit for a diesel-water fuel emulsion, or a producer claiming a
credit for an alcohol fuel mixture, biodiesel or renewable diesel
mixture, or an alternative fuel mixture.
Instead of waiting to claim an annual credit on Form 4136,
you may file:
• Form 8849, Claim for Refund of Excise Taxes, to claim a
periodic refund; or
• Form 720, Quarterly Federal Excise Tax Return, to claim a
credit against your taxable fuel liability.

You cannot claim any amounts on Form 4136 that you
claimed on Form 8849 or Schedule C (Form 720).

CAUTION

Partnerships. Partnerships (other than electing large
partnerships) cannot file this form. Instead, they must include a
statement on Schedule K-1 (Form 1065), Partner’s Share of
Income, Deductions, Credits, etc., showing the allocation to
each partner specifying the number of gallons of each fuel used
during the tax year, the applicable credit per gallon, the
nontaxable use or sale, and any additional information required
to be submitted.

Additional Information
• Publication 510, Excise Taxes for 2006, has more information

on nontaxable uses and the definitions of terms, such as
ultimate vendor and blocked pump. Pub. 510 also contains
information on fuel tax credits and refunds previously in
Pub. 378.
• Publication 225, Farmer’s Tax Guide, also includes
information on credits and refunds for the federal excise tax on
fuels applicable to farmers.
• Notice 2005-4. You can find Notice 2005-4 on page 289 of
Internal Revenue Bulletin 2005-2 at www.irs.gov/pub/irs-irbs/
irb05-02.pdf.
• Notice 2005-62. You can find Notice 2005-62 on page 443 of
Internal Revenue Bulletin 2005-35 at www.irs.gov/pub/irs-irbs/
irb05-35.pdf.
• Notice 2005-80. You can find Notice 2005-80 on page 953 of
Internal Revenue Bulletin 2005-46 at www.irs.gov/pub/irs-irbs/
irb05-46.pdf.
• Notice 2006-92. You can find Notice 2006-92 in Internal
Revenue Bulletin 2006-43 at www.irs.gov/pub/irs-irbs/irb06-43.
pdf.

Recordkeeping
You must keep records to support any credits claimed on this
return for at least 3 years from the date the return is due or
filed, whichever is later.

Including the Fuel Tax Credit in Income
You must include in your gross income the amount of the credit
from line 20 if you took a deduction on your tax return that
included the amount of the taxes and that deduction reduced
your income tax liability. See Pub. 510 for more information.

Specific Instructions
How To Make A Claim
Complete all information requested for each claim you make.
You must enter the number (when requested) from the Type of
Use Table on page 2, the number of gallons or gasoline gallon
equivalents (CNG only), and the amount of credit. If you need
more space for any line (for example, for more types of use),
prepare a separate sheet using the same format as the line.
Attach separate sheets showing any additional information
required for your claim such as the computation of the amount
to be credited. Be sure to write your name and taxpayer
identification number (TIN) on each sheet.

Cat. No. 48249T

Page 2 of 4

Instructions for Form 4136

6:30 - 6-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Amount of credit. Generally, multiply the rate by the number
of gallons. For lines 12 and 13, enter the number of gallons of
alcohol or biodiesel/renewable diesel. For lines 14 and 15, enter
the number of gallons or gasoline gallon equivalents (CNG
only). Enter the result (or the combined result as indicated by
the brackets) in the amount of credit column. Include amounts
from any separate sheets.

An income tax credit for gasoline and aviation gasoline
can be claimed on Form 4136 by the ultimate purchaser
CAUTION only. Claims by registered credit card issuers and
registered ultimate vendors for gasoline and aviation gasoline
sold to a state or local government or nonprofit educational
organization must be made on Schedule C (Form 720) or
Form 8849.

Line 1. Nontaxable Use of Gasoline

Exported taxable fuel. The claim rates for exported taxable
fuel are listed on lines 1d, 2c, 3e, 4d, 19a, and 19b. Taxpayers
making a claim for exported taxable fuel must include with their
records proof of exportation. Proof of exportation includes:
• A copy of the export bill of lading issued by the delivering
carrier,
• A certificate by the agent or representative of the export
carrier showing accrual exportation of the fuel,
• A certificate of lading signed by a customs officer of the
foreign country to which the fuel is exported, or
• A statement of the foreign consignee showing receipt of the
fuel.

Claimant. The ultimate purchaser of the gasoline is the only
person eligible to make this claim.
Allowable uses. A claim cannot be made for personal use of
any fuel on line 1. Also, for lines 1a and 1c, a claim cannot be
made for any use in a motorboat, other than commercial fishing.
For line 1a, the gasoline must have been used during the
period of claim for a business use other than in a highway
vehicle registered (or required to be registered) for highway use
(Type of use 2).
For line 1b, the gasoline must have been used during the
period of claim on a farm for farming purposes (Type of use 1).
For line 1c, the gasoline must have been used during the
income tax year for type of use 4, 5, 7, 11, 13, 14, or 15. For
type of use 13 or 14, claimant has not waived the right to make
a claim. See Type of use 13 and 14 above.
For line 1d, the gasoline must have been exported during the
period of claim (Type of use 3). See Exported taxable fuel
above.

Type of Use Table
The following table lists the nontaxable uses of fuels. You must
enter the number from the table in the Type of use column on
Form 4136.
No.

Type of Use

On a farm for farming purposes

Off-highway business use (for business use other than in
a highway vehicle registered or required to be registered
for highway use) (other than use in mobile machinery)

Export

In a boat engaged in commercial fishing

In certain intercity and local buses

In a qualified local bus

In a bus transporting students and employees of schools
(school buses)

For diesel fuel and kerosene (other than kerosene used in
aviation) used other than as a fuel in the propulsion engine
of a train or diesel-powered highway vehicle (but not
off-highway business use)

In foreign trade

Certain helicopter and fixed-wing aircraft uses

Exclusive use by a qualified blood collector organization
(beginning after December 31, 2006)

In a highway vehicle owned by the United States that is
not used on a highway

Exclusive use by a nonprofit educational organization

Exclusive use by a state, political subdivision of a state, or
the District of Columbia

In an aircraft or vehicle owned by an aircraft museum

In military aircraft

For use in the production of alternative fuel

Line 2. Nontaxable Use of Aviation Gasoline
Claimant. The ultimate purchaser of the aviation gasoline is
the only person eligible to make this claim.
Allowable uses. For line 2b, the aviation gasoline must have
been used during the period of claim for type of use 1, 10, 11,
13, 14, or 15. For type of use 13 or 14, claimant has not waived
the right to make a claim. See Type of use 13 and 14 above.
For line 2c, the aviation gasoline must have been exported
during the period of claim (Type of use 3). See Exported
taxable fuel above.

Line 3. Nontaxable Use of Undyed Diesel Fuel
Claimant. The ultimate purchaser of the diesel fuel is the only
person eligible to make this claim.
Allowable uses. For line 3a, the diesel fuel must have been
used during the period of claim for type of use 2, 6, 7, 8, 11, 13,
14, or 15. For line 3d, the claimant has not waived the right to
make a claim. See Type of use 13 and 14 above. Type of use 8
includes use as heating oil and use in a motorboat.
For line 3e, the diesel fuel must have been exported during
the period of claim (Type of use 3). See Exported taxable fuel
above.

Line 4. Nontaxable Use of Undyed Kerosene (Other
Than Kerosene Used in Aviation)
Claimant. The ultimate purchaser of the kerosene is the only
person eligible to make this claim.
Allowable uses. For line 4a, the kerosene must have been
used during the period of claim for type of use 2, 6, 7, 8, 11, 13,
14, or 15. Line 4b does not include claims for kerosene used in
aviation for farming purposes; instead, see line 8d. For line 4c,
the claimant has not waived the right to make a claim. See
Type of use 13 and 14 above. Type of use 8 includes use as
heating oil and use in a motorboat.
For line 4d, the kerosene must have been exported during
the period of claim (Type of use 3). See Exported taxable fuel
above.

Type of use 13 and 14. Generally, claims for sales of diesel
fuel, kerosene, kerosene for use in aviation, gasoline, or
aviation gasoline for the exclusive use of a state or local
government (and nonprofit educational organization for gasoline
or aviation gasoline) must be made following the order below.
1. By the registered credit card issuer if the state or local
government (or nonprofit educational organization if applicable)
used a credit card and the credit card issuer meets the four
requirements discussed in Line 16. Registered Credit Card
Issuers on page 4.
2. By the registered ultimate vendor if the ultimate
purchaser did not use a credit card and waives his or her right
to make the claim and the registered credit card issuer cannot
make the claim.
3. By the ultimate purchaser if the ultimate purchaser used
a credit card and neither the registered credit card issuer nor
the registered ultimate vendor is eligible to make the claim.

You may claim a credit for the tax on undyed kerosene

TIP you purchased (other than from a blocked pump) and

used in your home during 2006 for heating, lighting, or
cooking.
To claim the credit on line 4a for home use:
1. Enter 8 in col. (a).
2. Enter the number of gallons of kerosene in col. (c).
3. Multiply the gallons in col. (c) by $.243. Enter the result in
col. (d).
4. If this is the only fuel tax credit you are claiming, enter the
amount from col. (d) on:
a. Line 20 of Form 4136, and
b. Line 70 of Form 1040. Also, check box “b” on line 70.

Additional requirements that must be met are in Pub. 510.

-2-

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Instructions for Form 4136

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Line 5. Kerosene Used in Commercial Aviation (Other
Than Foreign Trade)

Line 7c. Sales by Registered Ultimate Vendors of
Undyed Kerosene for Use in Certain Intercity and
Local Buses

Claimant. The ultimate purchaser of the kerosene used in
commercial aviation (other than foreign trade) is eligible to
make this claim.
Allowable uses. For lines 5a and 5b, claimant certifies that the
right to make the claim has not been waived. If the claimant
buys kerosene partly for use in commercial aviation and partly
for use in noncommercial aviation, see the rules in Notice
2005-80, section 3(e)(3). Only one claim may be filed for any
gallon of kerosene used in commercial aviation.

Claimant. For line 7c, the registered ultimate vendor of the
kerosene is eligible to make a claim only if the buyer waives his
or her right to make the claim by providing the registered
ultimate vendor with an unexpired waiver. See Model Waiver N
in Pub. 510. Only one claim may be filed for any gallon of
kerosene.
Registration number. Enter your UB registration number in
the space provided.

Line 8a and 8b. Sales By Registered Ultimate
Vendors of Kerosene For Use in Commercial Aviation
(Other Than Foreign Trade)

Information for Claims on Lines 6 –8
Registration number. To make an ultimate vendor claim on
lines 6 – 8 you are required to be registered. Enter your
registration number, including the prefix, on the applicable line
for your claim. If you are not registered, you cannot make a
claim at this time. Use Form 637, Application for Registration
(For Certain Excise Tax Activities), to apply for one.
Required certificates or waiver. The required certificates or
waivers for lines 6 – 8 are listed in the line instructions and are
available in Pub. 510.

Claimant. The registered ultimate vendor of the kerosene sold
for use in commercial aviation is eligible to make this claim only
if the buyer waives his or her right by providing the registered
ultimate vendor with an unexpired waiver. See Model Waiver L
in Pub. 510. Only one claim may be filed for any gallon of
kerosene sold for use in commercial aviation.
Allowable sales. The kerosene sold for use in commercial
aviation must have been sold during the period of claim for use
in commercial aviation (other than foreign trade).
Registration number. Enter your UA registration number in
the space provided.

Line 6a. Sales by Registered Ultimate Vendors of
Undyed Diesel Fuel
Claimant. For line 6a, the registered ultimate vendor of the
diesel fuel is the only person eligible to make this claim and has
obtained the required certificate from the buyer and has no
reason to believe any information in the certificate is false. See
Model Certificate P in Pub. 510. Only one claim may be filed for
any gallon of diesel fuel.
Allowable sales. The fuel must have been sold during the
period of claim for the exclusive use by a state or local
government (including essential government use by an Indian
tribal government).
Registration number. Enter your UV registration number in
the space provided.
Information to be submitted. For claims on line 6a, attach a
separate sheet with the name and TIN of each governmental
unit to whom the diesel fuel was sold and the number of gallons
sold to each.

Line 8c, 8d, and 8e. Sales By Registered Ultimate
Vendors of Kerosene Sold For Use in Noncommercial
Aviation
Claimant. The registered ultimate vendor of the kerosene sold
for use in noncommercial aviation is the only person eligible to
make this claim and has obtained the required certificate from
the ultimate purchaser. For type of use 1, 9, 10, 13, or 15, see
Model Certificate Q in Pub. 510. For type of use 14, see Model
Certificate P in Pub. 510. Only one claim may be filed for any
gallon of kerosene sold for use in noncommercial aviation.
Allowable sales. For line 8c, the kerosene must have been
sold for a nonexempt use in noncommercial aviation. For lines
8d and 8e, the kerosene sold for use in noncommercial aviation
must have been sold during the period of claim for type of use
1, 9, 10, 11, 13, 14, or 15.
Registration number. Enter your UA (UV if type of use 14)
registration number in the space provided.

Line 6b. Sales by Registered Ultimate Vendors of
Undyed Diesel Fuel for Use in Certain Intercity and
Local Buses

Line 9. Reserved for future use.
Line 10. Reserved for future use.

Claimant. For line 6b, the registered ultimate vendor of the
diesel fuel is eligible to make a claim only if the buyer waives
his or her right to make the claim by providing the registered
ultimate vendor with an unexpired waiver. See Model Waiver N
in Pub. 510. Only one claim may be filed for any gallon of diesel
fuel.
Registration number. Enter your UB registration number in
the space provided.

Line 11. Nontaxable Use of Liquefied Petroleum Gas
(LPG) (before October 1, 2006)
Allowable uses. For line 11c, the taxed LPG must have been
used for type of use 1, 2, 4, 7, 13, 14, or 15. A credit for
nontaxable use of LPG after September 30, 2006 must be
claimed on line 14a.

Line 12. Alcohol Fuel Mixture Credit

Line 7a and 7b. Sales by Registered Ultimate
Vendors of Undyed Kerosene (Other Than Kerosene
for Use in Aviation)

Claimant. The person that produced and sold or used the
mixture in their trade or business is the only person eligible to
make this claim. The credit is based on the gallons of alcohol in
the mixture.
Registration number. If you are a registered blender or a
taxable fuel registrant, enter your registration number, including
the prefix, on line 12.
How to claim the credit. Any alcohol fuel mixture credit must
first be taken on Schedule C to reduce your taxable fuel liability
reported on Form 720. Any excess credit may be taken on
Schedule C (Form 720), Form 8849, Form 4136, or Form 6478.
See Notice 2005-4 and Notice 2005-62 for more information.

Claimant. For line 7a, the registered ultimate vendor of the
kerosene is the only person eligible to make this claim and has
obtained the required certificate from the buyer and has no
reason to believe any information in the certificate is false. See
Model Certificate P in Pub. 510. For line 7b, claimant has a
statement, if required, that contains: the date of sale, name and
address of the buyer, and the number of gallons of kerosene
sold to the buyer. For lines 7a and 7b, only one claim may be
filed for any gallon of kerosene.
Allowable sales. The fuel must have been sold during the
period of claim:
• For line 7a, use by a state or local government (including
essential government use by an Indian tribal government), or
• For line 7b, from a blocked pump.
Registration number. Enter your UV or UP registration
number in the space provided.
Information to be submitted. For claims on line 7a, attach a
separate sheet with the name and TIN of each governmental
unit to whom the kerosene was sold and the number of gallons
sold to each.

Line 13. Biodiesel or Renewable Diesel Mixture Credit
Claimant. The person that produced and sold or used the
mixture in their trade or business is the only person eligible to
make this claim. The credit is based on the gallons of biodiesel
or renewable diesel in the mixture. The biodiesel used to
produce the biodiesel mixture must meet ASTM D6751 and be
registered with the EPA as a fuel and fuel additive under
section 211 of the Clean Air Act.
Certificate. The Certificate for Biodiesel and, if applicable,
Statement of Biodiesel Reseller, must be attached to the first
claim filed that is supported by the certificate or statement. See

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Page 4 of 4

Instructions for Form 4136

6:30 - 6-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Model Certificate O and Model Certificate S in Pub. 510. If the
certificate and statement are not attached to Form 4136
because they are attached to a previously-filed claim on
Schedule C (Form 720) or Schedule 3 (Form 8849) for the
biodiesel, attach a separate sheet with the following
information.
1. Certificate identification number.
2. Total gallons of biodiesel on certificate.
3. Total gallons claimed on Schedule 3 (Form 8849).
4. Total gallons claimed on Schedule C (Form 720),
line 13.

4. Has in its possession an unexpired certificate from the
ultimate purchaser and has no reason to believe any of the
information in the certificate is false. See Model Certificate R in
Pub. 510.
If any of these conditions is not met, the credit card issuer
must collect the tax from the ultimate purchaser and only the
ultimate purchaser can make the claim.
Allowable sales. The diesel fuel, kerosene, or kerosene for
use in aviation must have been purchased with a credit card
issued to the ultimate purchaser during the period of claim for
the exclusive use by a state or local government (including
essential government use by an Indian tribal government).
Registration number. Enter your CC registration number in
the space provided.
For line 16c, if the kerosene was taxed at $.244, the
credit rate is $.243. Write “Taxed at $.244” in the space
CAUTION to the left of column (a). Enter $.243 in column (b).

Registration number. If you are a registered blender or a
taxable fuel registrant, enter your registration number, including
the prefix, on line 13.
How to claim the credit. Any biodiesel or renewable diesel
mixture credit must first be taken on Schedule C to reduce your
taxable fuel liability reported on Form 720. Any excess credit
may be taken on Schedule C (Form 720), Form 8849, Form
4136, or Form 8864. See Notice 2005-4 and Notice 2005-62 for
more information.
For lines 14 and 15, see Notice 2006-92.

Line 17. Nontaxable Use of a Diesel-Water Fuel
Emulsion
Claimant. The ultimate purchaser of the diesel-water fuel
emulsion is the only person eligible to make this claim.
Allowable uses. For line 17a, the diesel-water fuel emulsion
must have been used during the period of claim for type of use
1, 2, 5, 6, 7, 8, 11, 13, 14, or 15. For line 17b, the diesel-water
fuel emulsion must have been exported during the period of
claim (Type of use 3). See Exported taxable fuel on page 2.
Type of use 5. Write “Bus” in the space to the left of column
(a). Enter the correct credit amount in column (b). The credit
rate for type of use 5 is $.124 per gallon.

TIP

Line 14. Nontaxable Use of Alternative Fuel (after
September 30, 2006)
Claimant. The ultimate purchaser of the taxed alternative fuel
is the only person eligible to make this claim.
Allowable uses. The alternative fuel must have been used
after September 30, 2006, for type of use 1, 2, 4, 5, 6, 7, 11, 13,
14, or 15.
Type of use 5. Write “Bus” in the space to the left of column
(a). Enter the correct credit amount in column (b). The credit
rates for type of use 5 are listed below.
Line number

Line 18. Diesel-Water Fuel Emulsion Blending
Claimant. The person that produced (the blender) and sold or
used the diesel-water fuel emulsion is the only person eligible to
make this claim.
Registration number. Enter your M registration number in the
space provided.
Information to be submitted. The blender must attach a
statement to the claim certifying that:
• The diesel-water fuel emulsion contains at least 14% water,
• The emulsion additive is registered by a United States
manufacturer under section 211 of the Clean Air Act with the
Environmental Protection Agency,
• Undyed diesel fuel taxed at $.244 was used to produce the
diesel-water fuel emulsion, and
• The diesel-water fuel emulsion was used or sold for use in
the blender’s trade or business.

Credit rate

14a

$.109

14b

.110

14c

.109*

14d

.110

14e

.17

14f

.17

14g

.169

*This is the credit rate per gasoline gallon equivalent (126.67 cu. ft. of CNG).

Line 19. Exported Dyed Fuel
Claimant. The person that exported dyed diesel fuel or dyed
kerosene during the period of claim is the only person eligible to
make this claim. See Exported taxable fuel on page 2.

Line 15. Alternative Fuel Credit and Alternative Fuel
Mixture Credit (after September 30, 2006)
Claimant. For the alternative fuel credit, the person who sold
an alternative fuel for use in a motor vehicle or a motorboat or
used an alternative fuel in a motor vehicle or a motorboat is the
only person eligible to make this claim.
For the alternative fuel mixture credit, the person that
produced and sold or used the mixture in their trade or business
is the only person eligible to make this claim. The credit is
based on the gallons of alternative fuel in the mixture.
Registration number. You must enter your registration
number, including the prefix, in the space provided.
How to claim the credit. Any alternative fuel credit and
alternative fuel mixture credit must first be taken on Schedule C
(Form 720) to reduce your taxable fuel liability reported on Form
720. Any excess credit may be taken on Schedule C (Form
720), Form 8849, or Form 4136.

Paperwork Reduction Act Notice. We ask for the information
on Form 4136 to carry out the Internal Revenue laws of the
United States. We need it to ensure that you are complying with
these laws and to allow us to figure and collect the right amount
of tax.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated burden
for individual taxpayers filing this form is approved under OMB
control number 1545-0074 and is included in the estimates
shown in the instructions for Form 1040. The estimated burden
for all other taxpayers is shown below. Recordkeeping, 41hr.,
47 min.; Learning about the law or the form, 6 min.;
Preparing and sending the form to the IRS, 49 min.
If you have comments concerning the accuracy of these time
estimates or suggestions for making Form 4136 simpler, we
would be happy to hear from you. You can write to the Internal
Revenue Service at the address listed in the instructions of the
tax return with which Form 4136 is filed.

Line 16. Registered Credit Card Issuers
Claimant. The registered credit card issuer is the only person
eligible to make this claim if the credit card issuer:
1. Is registered by the IRS;
2. Has not collected the amount of tax from the ultimate
purchaser or has obtained the written consent of the ultimate
purchaser to make the claim;
3. Certifies that it has repaid or agreed to repay the amount
of tax to the ultimate vendor, has obtained the written consent
of the ultimate vendor to make the claim, or has otherwise
made arrangements which directly or indirectly provide the
ultimate vendor with reimbursement of the tax; and

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File Type	application/pdf
File Title	2005 Form 1040
Subject	U.S. Individual Income Tax Return
Author	SE:W:CAR:MP
File Modified	2006-12-30
File Created	2006-12-30