Form 720 - Sch C 720 - Sch C Quarterly Federal Excise Tax Return - Sch. C

Form 720 (Rev. 7-2010)

Page

4

Schedule C
Claims
Month your income tax year ends ▶
• Complete Schedule C for claims only if you are reporting liability in Part I or II of Form 720.
• Attach a statement explaining each claim as required. Include your name and EIN on the statement (see instructions).
Caution. Claimant has the name and address of the person(s) who sold the fuel to the claimant, the dates of purchase, and if
exported, the required proof of export. For claims on lines 1a and 2b (type of use 13 and 14), 3c, 4b, and 5, claimant has not waived
the right to make the claim.
Note: CRN is credit reference number.
Period of claim ▶
1
Nontaxable Use of Gasoline
Type of use

a Gasoline (see Caution above line 1)
b Exported (see Caution above line 1)
2
Nontaxable Use of Aviation Gasoline
Type of use

a
b
c
d
3

4

5

Amount of claim

CRN

Rate

Gallons

362
411
Amount of claim

Rate

Gallons

CRN

354
324
412
433

.

.

.

Amount of claim

$
$.243
.243
.17
.243
.244
Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation) Period of 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 a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type of use

Rate

Gallons

360
353
350
360
413

.

.

Amount of claim

$
$.243
.17
.243
.244
.043
.218
Period of claim ▶

Nontaxable use
Use in certain intercity and local buses (see Caution above line 1)
Use on a farm for farming purposes
Exported (see Caution above line 1)
Nontaxable use taxed at $.044
Nontaxable use taxed at $.219
Kerosene Used in Aviation (see Caution above line 1)
Type of use

Rate

Gallons

▶

CRN

Nontaxable use
Use in trains
Use in certain intercity and local buses (see Caution above line 1)
Use on a farm for farming purposes
Exported (see Caution above line 1)

Caution. Claims cannot be made on line 4 for kerosene sales from a blocked pump.

a
b
c
d
e
f

Gallons

$
Used in commercial aviation (other than foreign trade)
$.15
Other nontaxable use (see Caution above line 1)
.193
Exported (see Caution above line 1)
.194
LUST tax on aviation fuels used in foreign trade
.001
Nontaxable Use of Undyed Diesel Fuel
Period of 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 a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type of use

a
b
c
d
e

Rate

$
$.183
.184
Period of claim ▶

.

▶

CRN

346
347
346
414
377
369
Amount of claim

CRN

a

Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244
b Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219
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
e LUST tax on aviation fuels used in foreign trade

$.200

$

417

.175

355

.243

346

.218
.001

369
433
Form 720 (Rev. 7-2010)

Form 720 (Rev. 7-2010)

6

Page

5

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 instructions).
Type of use

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
a
b
c
d
e

Rate

Gallons or gasoline
gallon equivalents
(GGE)

Amount of claim
$

$.183
.183
.183
.183

CRN

419
420
421
422

.243
.243
.243
.183

423
424
425
435

Period of claim ▶
Registration number ▶
Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained
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 a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

7

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Rate

Gallons

Amount of claim

CRN

$
a Use by a state or local government
360
$.243
b Use in certain intercity and local buses
.17
350
▶
Sales by Registered Ultimate Vendors of Undyed Kerosene
Period
of
claim
8
(Other Than Kerosene For Use in Aviation)
Registration number ▶
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 a detailed
explanation and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
Rate

a Use by a state or local government
b Sales from a blocked pump
c Use in certain intercity and local buses
9

Gallons

$.243
.243
.17

Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

Amount of claim
$

CRN

346
347

Registration number ▶

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 written consent of the buyer to make the claim. See the
instructions for additional information to be submitted.
Type of use

a
b
c
d
e
f
10

Use in commercial aviation (other than foreign trade) taxed at $.219
Use in commercial aviation (other than foreign trade) taxed at $.244
Nonexempt use in noncommercial aviation
Other nontaxable uses taxed at $.244
Other nontaxable uses taxed at $.219
LUST tax on aviation fuels used in foreign trade
Sales by Registered Ultimate Vendors of Gasoline

Rate

Gallons

Amount of claim
$

$.175
.200
.025
.243
.218
.001

CRN

355
417
418
346
369
433

Registration number ▶

Claimant sold the gasoline 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 written consent of the buyer to take the claim; and obtained an unexpired
certificate from the buyer and has no reason to believe any information in the certificate is false. See the instructions for
additional information to be submitted.
Rate

a Use by a nonprofit educational organization
b Use by a state or local government

$.183
.183

Gallons

Amount of claim
$

CRN

362
Form 720 (Rev. 7-2010)

Form 720 (Rev. 7-2010)

11

Page

6

Registration number
Sales by Registered Ultimate Vendors of Aviation Gasoline
Claimant sold the aviation gasoline 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 written consent of the buyer to take the claim; and obtained an unexpired certificate from the buyer
and has no reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.
▶

Rate

a Use by a nonprofit educational organization
b Use by a state or local government

Gallons

Amount of claim
$

$.193
.193

CRN

324

Period of claim ▶
Registration number ▶
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 (see instructions).

12

Alcohol Fuel Mixture Credit

Rate

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

Gallons

Amount of claim
$

$.45
.60

CRN

393
394

Period of claim ▶
Registration number ▶

Biodiesel or Renewable Diesel Mixture Credit

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, 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, Statement of Biodiesel Reseller,
both of which have been edited as discussed in the instructions for line 13. See the instructions for line 13 for information about renewable diesel used in aviation.

Caution. All of the credits on line 13 expired on December 31, 2009 (see Rate Gal. of biodiesel or Amount of claim
renewable Diesel
instructions).
$
a Biodiesel (other than agri-biodiesel) mixtures
$1.00
b Agri-biodiesel mixtures
1.00
c Renewable diesel mixtures
1.00
Registration number ▶
14
Alternative Fuel Credit and Alternative Fuel Mixture Credit

CRN

388
390
307

For the alternative fuel mixture credit, claimant produced a mixture by mixing taxable fuel with alternative fuel. Claimant certifies that it (a)
produced the alternative fuel, or (b) has in its possession the name, address, and EIN of the person(s) that sold the alternative fuel to the
claimant; the date of purchase; and an invoice or other documentation identifying the amount of the alternative fuel. The claimant also
certifies that it made no other claim for the amount of the alternative fuel, or has repaid the amount to the government. The alternative fuel
mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant.

Caution. All of the credits on line 14 except for the liquefied hydrogen
credit (line 14d) expired on December 31, 2009 (see instructions).
a
b
c
d
e
f
g
h
i
15

Rate

Gallons or
gasoline gallon
equivalents (GGE)
(see instructions)

Amount of claim

$
Liquefied petroleum gas (LPG)
$.50
“P Series” fuels
.50
Compressed natural gas (CNG) (GGE = 121 cu. ft.)
.50
Liquefied hydrogen
.50
Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process
.50
Liquid fuel derived from biomass
.50
Liquefied natural gas (LNG)
.50
Liquefied gas derived from biomass
.50
Compressed gas derived from biomass (GGE = 121 cu. ft.)
.50
Other claims. See the instructions. For lines 15b and 15c, see the Caution above line 1 on page 4.

426
427
428
429
430
431
432
436
437
Amount of claim

a
b
c
d
e

Section 4051(d) tire credit (tax on vehicle reported on IRS No. 33)
Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001
Exported dyed kerosene
Diesel-water fuel emulsion
Registered credit card issuers

$

Number of tires

f Taxable tires other than bias ply or super single tires
g Taxable tires, bias ply or super single tires (other than super single tires designed for steering)
h Taxable tires, super single tires designed for steering
i
j
k
16
Total claims. Add amounts on lines 1 through 15. Enter the result here and on Form 720, Part III, line 4.

CRN

366
415
416

Amount of claim
$

CRN

CRN
396
304
305

16
Form 720 (Rev. 7-2010)