4136 Credit for Federal Tax Paid on Fuels

Form

4136

OMB No. 1545-0162

Credit for Federal Tax Paid on Fuels
©

Department of the Treasury
Internal Revenue Service (99)

©

2008

See the separate instructions.

Attachment
Sequence No.

Attach this form to your income tax return.

Name (as shown on your income tax return)

23

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

(b) Rate

Off-highway business use
Use on a farm for farming purposes

.183

Other nontaxable use (see Caution above line 1)

.183

Exported

.184

3

%

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

Nontaxable Use of Aviation Gasoline
(a) Type of use

a
b
c
d

(c) Gallons

$ .183

Use in commercial aviation (other than foreign trade)

(b) Rate

(c) Gallons

(d) Amount of credit (e) CRN

Other nontaxable use (see Caution above line 1)

.193/.043*

354
324

Exported

.194/.044*

412

LUST tax on aviation fuels used in foreign trade
*This rate applies after March 31, 2009.

$

.15/.000*

$

433

.001

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
b Use on a farm for farming purposes
.243
c Use in trains
353
.243

%

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

e Exported

4

.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 taxed at $.244
.243
$
$
346
b Use on a farm for farming purposes
.243

%

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

d Exported
e Nontaxable use taxed at $.044
f Nontaxable use taxed at $.219
For Paperwork Reduction Act Notice, see the separate instructions.

.17
.244

347

.043

377

.218

369

Cat. No. 12625R

414

Form

4136

(2008)

Form 4136 (2008)

5

Page

2

Kerosene Used in Aviation (see Caution above line 1)
(a) Type
of use

(b) Rate

(c) Gallons

(d) Amount of credit (e) CRN

a Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244

$ .200

417

$

b Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219/.044*

.175/.000*

355

.243

346

c Nontaxable use (other than use by state or local
government) taxed at $.244

d Nontaxable use (other than use by state or local
government) taxed at $.219/.044*

369
433

.218/.043*

e LUST tax on aviation fuels used in foreign trade

.001

*This rate applies after March 31, 2009.

6

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

7

(c) Gallons

$

$ .243

360
350

.17

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

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

8

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/.044*
355
$.175/.000*
$

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

c
d
e
f

.200

417

Nonexempt use in noncommercial aviation

.025/.200*

Other nontaxable uses taxed at $.244
Other nontaxable uses taxed at $.219/.044*

.243
.218/.043*

418
346

LUST tax on aviation fuels used in foreign trade
*This rate applies after March 31, 2009.

369
433

.001
Form

4136

(2008)

Form 4136 (2008)

9

Page

Alcohol Fuel Mixture Credit

Registration No.

3

©

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)

(c) Gallons of
alcohol

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

$

$ .51/.45*
.60

*This rate applies after December 31, 2008.

10

Biodiesel or Renewable Diesel Mixture Credit

Registration No.

©

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met
ASTM D6751 and met EPA’s registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for
use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of
Biodiesel Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing renewable diesel with diesel fuel (other than
renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass (as defined in section
45K(c)(3)) using a thermal depolymerization process, met EPA’s registration requirements for fuels and fuel additives, and met ASTM D975
or D396. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has
attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller, both of which have been edited as discussed
in the Instructions for Form 4136. See the instructions for line 10 for details.
(c) Gallons of (d) Amount of credit (e) CRN
(b) Rate
biodiesel or
renewable
diesel
a Biodiesel (other than agri-biodiesel) mixtures
388
$
$.50/1.00*
390
1.00
b Agri-biodiesel mixtures

c Renewable diesel mixtures

1.00

307

*This rate applies after December 31, 2008.

11

Nontaxable Use of Alternative Fuel
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 5 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 fuel derived from biomass
g Liquefied natural gas (LNG)
h Liquefied gas derived from biomass

12

.243
.243
.243

423
424
425

.183

435

Alternative Fuel Credit and Alternative Fuel Mixture Credit

Registration No.
(b) Rate

(c) Gallons
or gasoline
gallon
equivalents (GGE)

©

(d) Amount of credit (e) CRN

a
b
c
d
e

Liquefied petroleum gas (LPG)

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

.50

f
g
h
i

Liquid fuel derived from biomass
Liquefied natural gas (LNG)

.50

430
431

.50

432

Liquefied gas derived from biomass

.50

436

Compressed gas derived from biomass (GGE = 121 cu. ft.)

.50

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

$ .50

$

426
427
428
429

.50
.50

.50

437
Form

4136

(2008)

Form 4136 (2008)

13

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

(b) Rate
$ .243
.243

(c) Gallons

4

©

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

c Kerosene for use in aviation sold for the exclusive use of a state or local
government taxed at $.219/.044*

.218/.043*

369

*This rate applies after March 31, 2009.

14

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 6 in the Instructions for Form 4136 for the credit rate.
(a) Type of use

a Nontaxable use
b Exported

15

(b) Rate
.198

(b) Rate

16

©

(c) Gallons

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

(c) Gallons

(d) Amount of credit (e) CRN

$ .046

Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate

a Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001
b Exported dyed kerosene

17

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

Registration No.

Diesel-Water Fuel Emulsion Blending

Blender credit

(c) Gallons

$ .197

$ .001

415
416

$

.001

Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on
Form 1040, line 68 (also check box b on line 68); Form 1120, line 32f(2); Form 1120S, line
23c; Form 1041, line 24g; or the proper line of other returns. ©

17 $
Form

4136

(2008)