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2009 Form 4136, Credit for Federal Tax Paid on Fuels
To
Symbol
Room
Action
Code
Initial/
Date
Yvette B.
Lawrence
Yvette Lawrence, Acting Section Chief
DB
Ron Gamble, Reviewer
Johnny Cervantes
Johnny Cervantes, Review Chief
Digitally signed by Yvette B. Lawrence
DN: cn=Yvette B. Lawrence, o, ou=SE:
W:CAR:MP:T:B:C, email=Yvette.B.
[email protected], c=US
Date: 2009.07.27 13:50:37 -04'00'
08/18/2009
Digitally signed by Johnny Cervantes
DN: cn=Johnny Cervantes, o=Internal Revenue Service, ou=SE:W:
CAR:MP:T:B:R, [email protected], c=US
Reason: I am approving this document
Date: 2009.08.27 14:32:36 -04'00'
OMB (if required)
✔
14. Prepare reply
for signature of
1. Per our
conversation
7. Signature
2. As requested
9. Note and return
8. Initials
3. Approval
10. Necessary action
4. Comments
11. See me
5. Information
12. Call me
6. Corrections
13. File
15. Please answer by
Remarks
PDF Approval Package:
Page 2: Project File Checksheet
Page 3: Record of Action on Assignment
Page 4: Implementation Plan
Page 5: Description of Major Changes
Pages 6-9: Marked-up PDF (cumulative changes)
Pages 10-13: Previous Version
From
Pamela Wright
Phone
(202) 622-3179
Room No.
IR-6141
Date
07/27/2009
Form 1725 (Rev. 7-2004)
Catalog Number 21215D
Department of the Treasury
Internal Revenue Service
2009 Form 4136, Credit for Federal Tax Paid on Fuels
Project File Checksheet
Action
No.
Oracle
P
Item
Initials
or N/A
Date
PW
04/22/2009
PW
06/03/2009
N/A
PW
06/04/2009
PW
06/03/2009
N/A
07/02/2009
First Draft
1
2
3
Deferred item(s) considered
Project file/R-set sent to review
Project file/R-set returned to section
✔
First Circulation
4
5
6
9
10
All review comments considered
Graphics/R-set sent to Publishing
Electronic file updated, spell checked and checked for
completeness
Composed pages/R-set proofread:
'100% 'Changes only Proofreader:
Proofreading changes put on electronic file and
checked for spelling and completeness
Circulation draft sent to reviewer/section chief
Circulation email sent
11
12
13
14
Circulation comments considered
Proofread 100% Proofreader:
Early release draft emailed to Publishing
Verified posting to website
7
8
N/A
✔
PW
06/23/2009
✔
PW
07/09/2009
Early Release of Form
N/A
N/A
✔
PW
07/20/2009
PW
07/27/2009
OK-to-Print
15
16
17
18
19
20
21
22
23
24
25
26
27
28
All comments considered
Reference checks completed
Math verified
Pub. 553 article(s) prepared
Project file/electronic file updated with changes
Spell checked/checked for completeness
Composed pages/R-set proofread:
'100% 'Changes only Proofreader:
Approved by TLS; sent to section chief
Approved by section chief, sent to reviewer
Approved by reviewer, sent to branch
Approved by branch, sent to TPCC Chair
Approved by TPCC Chair (OMB), sent to TLS
Electronic file updated with final comments, spell
checked and checked for completeness
Composed pages/R-set proofread:
'100% 'Changes only Proofreader:
Release
29
Released to Publishing (OK-To-Print)
N/A
PW
PW
06/03/2009
06/03/2009
N/A
N/A
PW
06/03/2009
N/A
✔
PW
07/27/2009
✔
yl
07/27/2009
✔
DB
08/18/2009
✔
JC
08/27/2009
Record of Actions on Assignment
Assignment:
Assigned to:
Reviewed by:
2009 Form 4136, Credit for Federal Tax Paid on Fuels
Date Started:
Pamela Wright
Date Completed:
04/22/2009
07/27/2009
Date Started:
Daniel Brooks
Date Completed:
08/18/2009
Record of Technical Developments Considered
Development
(Including Cite)
Description
Location
Action
1. P.L. 111-12 Sec. 2a
The aviation fuel rates have been A
2.
extended from March 31, 2009
3.
to December 31, 2009.
4.P.L. 110-343 Sec. 202(e)
Renewable diesel fuel is used as
Lines 2, 5, 8, & 13
TLS
Date
REV
Date
PW 04/23/2009
A
Line 10 PW 04/23/2009
5.
aviation fuel.
6. P.L. 110-343 Sec. 204(a)
The alternative fuel credit and A
Line 12 PW 04/23/2009
7.
the alternative fuel mixture
8.
credit has been extended from
9.
September 30, 2009 to
10.
December 31, 2009.
11.
12.
13.
Coordination with Other Offices (Use Specific Symbols)
Item
Pages
Sent to Other Offices
Topic
Symbols
1.
2.
3.
4.
5.
Action Codes:
Material initiated or revised on basis of this item.............................................. A
No action taken because:
Factual item .............................................................................. B
Already covered......................................................................... C
Limited applicability .................................................................... D
Other (explain) ........................................................................... E
Date
Returned
Target
Actual
Review of Comments
Initiator
Reviewer
Implementation Plan: Open Actions for Product 4136
Run by: SD_Y2HCB
Run date:
27-JUL-09
Reviewer: BROOKS, DANIEL
Action
Act
IRC
Number Section Section
Date
Type
Description of Action
Effective
Date
Target
Due Date
P.L. 110-343, Energy Improvement and Extension Act of 2008 (Division B)
66.00125
202(a)
66.00126
202(b)
66.00127
202(b)
40(g)
Revise product to reflect expiration of biodiesel
6427(e)(5)(B) and renewable diesel mixture credits on
Page 3
6436(c)(6) December 31, 2009 on Line 10
40A(b)
6426(c)
Revise product to reflect credit increase for
biodiesel mixtures to $1.00 on Line 10 Page
40A(b)
6426(c)
Revise product to reflect credit increase for
agribiodiesel mixtures to $1.00 on Line 10
A
12-DEC-2009
03-OCT-2009
A
31-DEC-2008
03-OCT-2009
A
31-DEC-2008
03-OCT-2009
A
3
Page 3
66.00128
202(c)
40A(f)
Revise product to reflect new definition/
requirements for renewable diesel in caption for
line 10 Page 3
31-DEC-2008
03-OCT-2009
66.00129
202(e)
40A(f)
Revise product to reflect renewable diesel use as
31-DEC-2009
A
aviation fuel, including treating kerosene as if it
were diesel fuel Page 3, See Line 10 of the Instructions
03-OCT-2009
66.00130
204(a)
A
Revise product to reflect allowance of alternative
fuel credit through 31-DEC-2009 from 30-SEP2009 including for line 12 [for fiscal yr filers] Page 3
31-DEC-2009
03-OCT-2009
66.00131
204(a)
Revise product to reflect allowance of alternative
fuel mixture credit through 31-DEC-2009 from 30SEP-2009 including for line 12 Page 3
31-DEC-2009
03-OCT-2009
6426(e)(3)
A
Description of Major Changes to the 2009 Form 4136, Credit for Federal Tax
Paid on Fuels
General
The edits were made to confirm to year references.
Pages 1, 2, and 4.
The aviation fuel rates have been extended from March 31, 2009 to September
30, 2009. The reference is to Line 2, Line 5, Line 8, and Line 13. P.L. 111-12
section 2a.
Page 3
The alcohol fuel mixture credit rate has changed from $0.51 to $0.45. The
reference is to Line 9a. P.L. 110-264 section 15331 and IRC 40.
The new definition and requirement for renewable diesel mixtures are provided.
The reference is in the caption under Line 10 for Biodiesel or Renewable Diesel
Mixture Credit. P.L. 110-343 section 202(c) and 40A (f).
Renewable diesel fuel as aviation fuel in which kerosene is treated as diesel fuel.
The reference is in the caption under Line 10. P.L. 110-343 section 202(e) and
40A (f).
The alternative fuel credit and the alternative fuel credit mixture credit, except for
liquefied hydrogen, are scheduled to expire after December 31, 2009. The
reference is made in the subscript under Line 12. P.L. 110-343 section 204(a)
and IRC 6424(e) (3).
Page 4
Line 17 on the form has been changed because the WRN for the Form 1040 for
2009 has renumbered the line to claim the credit from Form 4136. The credit is
now claimed on Line 70 instead of Line 68 on the 2009 Form 1040.
Approved for TPCC Chairperson "AS IS," Johnny Cervantes, August 27, 2009
Form
4136
Credit for Federal Tax Paid on Fuels
OMB No. 1545-0162
2009
© See
the separate instructions.
© Attach this form to your income tax return.
Department of the Treasury
Internal Revenue Service (99)
Name (as shown on your income tax return)
Version A, Cycle 3
Attachment
Sequence No. 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
Off-highway business use
Use on a farm for farming purposes
Other nontaxable use (see Caution above line 1)
(b) Rate
(c) Gallons
Exported
(d) Amount of credit
%
$ .183
.183
.183
(e) CRN
362
$
.184
411
Nontaxable Use of Aviation Gasoline
(a) Type of use
a
b
c
d
3
Use in commercial aviation (other than foreign trade)
Other nontaxable use (see Caution above line 1)
Exported
(b) Rate
(c) Gallons
(d) Amount of credit
$ .15/.000*
.193/.043*
.194/.044*
DRAFT AS OF
July 6, 2009
LUST tax on aviation fuels used in foreign trade
*This rate applies after September 30, 2009.
(e) CRN
354
324
412
$
.001
433
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
Nontaxable use
Use on a farm for farming purposes
Use in trains
Use in certain intercity and local buses (see Caution
above line 1)
e
Exported
4
a
b
c
d
(b) Rate
(c) Gallons
(d) Amount of credit
%
$ .243
.243
.243
(e) CRN
360
353
$
.17
.244
350
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
a Nontaxable use taxed at $.244
b Use on a farm for farming purposes
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.
(b) Rate
(c) Gallons
$ .243
.243
(d) Amount of credit
%
$
(e) CRN
346
.17
.244
347
414
.043
.218
377
369
Cat. No. 12625R
Form 4136 (2009)
Version A, Cycle 3
Page 2
Form 4136 (2009)
5
Kerosene Used in Aviation (see Caution above line 1)
(a) Type of use
a
Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244
(b) Rate
(c) Gallons
$ .200
(d) Amount of credit
(e) CRN
417
$
b Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219/.044*
c
Nontaxable use (other than use by state or local
government) taxed at $.244
.175/.000*
355
.243
346
.218/.043*
.001
369
433
d Nontaxable use (other than use by state or local
government) taxed at $.219/.044*
e
6
LUST tax on aviation fuels used in foreign trade
*This rate applies after September 30, 2009.
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
.17
.
.
(d) Amount of credit
©
(e) CRN
360
350
$
DRAFT AS OF
July 6, 2009 %
Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Kerosene For Use in Aviation)
.
Registration No. ©
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
a Use by a state or local government
b Sales from a blocked pump
c Use in certain intercity and local buses
8
Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation
(c) Gallons
.
.
(d) Amount of credit
.
©
(e) CRN
$ .243
.243
.17
$
346
347
Registration No. ©
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*
$ .175/.000*
$
355
b Use in commercial aviation (other than foreign trade) taxed
at $.244
c
d
e
f
Nonexempt use in noncommercial aviation
Other nontaxable uses taxed at $.244
Other nontaxable uses taxed at $.219/.044*
LUST tax on aviation fuels used in foreign trade
*This rate applies after September 30, 2009.
.200
.025/.200*
.243
417
418
346
.218/.043*
.001
369
433
Form 4136 (2009)
Version A, Cycle 3
Page 3
Form 4136 (2009)
9
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)
10
(c) Gallons of
alcohol
$ .45
(d) Amount of credit
393
$
.60
Biodiesel or Renewable Diesel Mixture Credit
(e) CRN
394
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 liquid fuel (other than renewable diesel).
The renewable diesel used to produce the renewable diesel mixture was derived from biomass process, met EPA’s registration requirements
for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. 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 information about renewable diesel used in aviation.
(b) Rate
a Biodiesel (other than agri-biodiesel) mixtures
b Agri-biodiesel mixtures
c Renewable diesel mixtures
(c) Gallons of
biodiesel or
renewable
diesel
$1.00/.000*
$1.00/.000*
$1.00/.000*
(d) Amount of credit
(e) CRN
388
390
307
$
DRAFT AS OF
July 6, 2009
*This rate applies after December 31, 2009.
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.
(a) Type of use
a
b
c
d
e
Liquefied petroleum gas (LPG)
“P Series” fuels
Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)
Liquefied hydrogen
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
Alternative Fuel Credit and Alternative Fuel Mixture Credit
(b) Rate
$ .183
Liquefied petroleum gas (LPG)
“P Series” fuels
Compressed natural gas (CNG) (GGE = 121 cu. ft.)
f
g
h
i
Liquid fuel derived from biomass
Liquefied natural gas (LNG)
Liquefied gas derived from biomass
Liquefied hydrogen
Any liquid fuel derived from coal (including peat) through the
Fischer-Tropsch process
Compressed gas derived from biomass (GGE = 121 cu. ft.)
*This rate applies after December 31, 2009.
(e) CRN
419
$
.183
.183
.183
420
421
422
.243
.243
423
424
.243
.183
425
435
Registration No. ©
(b) Rate
a
b
c
d
e
(d) Amount of credit
(c) Gallons
or gasoline
gallon
equivalents (GGE)
$ .50/000*
.50/.000*
.50/.000*
.50
.50/.000*
.50/.000*
.50/.000*
.50/.000*
.50/.000*
(d) Amount of credit
(c) Gallons
or gasoline
gallon
equivalents (GGE)
$
(e) CRN
426
427
428
429
430
431
432
436
437
Form 4136 (2009)
Version A, Cycle 3
Page 4
Form 4136 (2009)
13
Registered Credit Card Issuers
Registration No. ©
(b) Rate
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
government taxed at $.219/.044*
(c) Gallons
$ .243
(d) Amount of credit
(e) CRN
360
$
.243
346
.218/.043*
369
*This rate applies after September 30, 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
Diesel-Water Fuel Emulsion Blending
16
(d) Amount of credit
(e) CRN
309
306
$
Registration No. ©
DRAFT AS OF
July 6, 2009
(b) Rate
Blender credit
(c) Gallons
$ .197
.198
(c) Gallons
$ .046
(d) Amount of credit
(e) CRN
310
$
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
(c) Gallons
$ .001
(d) Amount of credit
$
.001
Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on Form
1040, line 70 (also check box b on line 70); Form 1120, line 32f(2); Form 1120S, line 23c; Form
1041, line 24g; or the proper line of other returns. ©
(e) CRN
415
416
17 $
Form 4136 (2009)
6
TLS, have you
transmitted all R
text files for this
cycle update?
Date
Form
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 406mm (16") 3 279mm (11") folded to 203mm (8") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
4136
Action
Date
O.K. to print
Revised proofs
requested
OMB No. 1545-0162
Credit for Federal Tax Paid on Fuels
Name (as shown on your income tax return)
2008
f
o
s
a
8
t
0
f
0
a
2
r
/
D /30 %
0
1
©
Department of the Treasury
Internal Revenue Service (99)
Signature
©
See the separate instructions.
Attachment
Sequence No.
Attach this form to 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
Off-highway business use
Use on a farm for farming purposes
(b) Rate
3
(d) Amount of credit (e) CRN
$
.183
Other nontaxable use (see Caution above line 1)
.183
Exported
.184
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)
6
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 406mm (16") 3 279mm (11") folded to 203mm (8") 3 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2008)
5
Page
2
Kerosene Used in Aviation (see Caution above line 1)
f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
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*
.218/.043*
e LUST tax on aviation fuels used in foreign trade
*This rate applies after March 31, 2009.
6
.001
Sales by Registered Ultimate Vendors of Undyed Diesel Fuel
Registration No.
369
433
©
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)
6
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 3 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 406mm (16") 3 279mm (11") folded to 203mm (8") 3 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2008)
9
Alcohol Fuel Mixture Credit
Page
Registration No.
3
©
f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
1
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)
*This rate applies after December 31, 2008.
10
(c) Gallons of
alcohol
(d) Amount of credit (e) CRN
$
$ .51/.45*
.60
Biodiesel or Renewable Diesel Mixture Credit
Registration No.
393
394
©
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)
6
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 4 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 406mm (16") 3 279mm (11") folded to 203mm (8") 3 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2008)
13
Registered Credit Card Issuers
Page
Registration No.
©
f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
1
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*
*This rate applies after March 31, 2009.
14
.218/.043*
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 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)
| File Type | application/pdf |
| File Title | Form 1725 (Rev. 7-2004) |
| Subject | Routing Slip |
| Author | efcoll07 |
| File Modified | 2009-08-27 |
| File Created | 2009-07-27 |