U.S. Individual Income Tax Return

2011

Instructions for Form 4136,
Credit for Federal Tax Paid
on Fuels
Section references are to the Internal Revenue Code unless
otherwise noted.

!

CAUTION

What’s New
Expiration of credits. The credits for alcohol fuel
mixtures, biodiesel mixtures, renewable diesel mixtures,
alternative fuels (except liquefied hydrogen), and
alternative fuel mixtures (except liquefied hydrogen)
expire December 31, 2011.
The IRS has created a page on IRS.gov for
information about Form 4136 and its instructions, at
www.irs.gov/form4136. Information about any future
developments affecting Form 4136 (such as legislation
enacted after we release it) will be posted on that page.

Reminders
Aviation fuel used outside the propulsion system of
an aircraft. Use line 2b to make a claim for aviation
gasoline used outside the propulsion system of an
aircraft. Depending on the tax rate of the kerosene, use
lines 4a, 4e, or 4f to make a claim for kerosene used
outside the propulsion system of an aircraft. For more
information, see Line 2. Nontaxable Use of Aviation
Gasoline and Line 4. Nontaxable Use of Undyed
Kerosene (Other Than Kerosene Used in Aviation).

General Instructions
Purpose of Form
Use Form 4136 to claim a credit for certain nontaxable
uses (or sales) of fuel during your 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, a biodiesel or renewable diesel mixture, or
an alternative fuel mixture.
Instead of waiting to claim an annual credit on Form
4136, you may be able to 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 tax liability.
Dec 05, 2011

Department of the Treasury
Internal Revenue Service

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

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
• Pub. 510, Excise Taxes, 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.
• Pub. 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 (IRB) 2005-2 at
www.irs.gov/irb/2005-02_IRB/ar14.html.
• Notice 2005-24. You can find Notice 2005-24 on page
757 of (IRB) 2005-12 at
www.irs.gov/irb/2005-12_IRB/ar13.html.
• Notice 2005-62. You can find Notice 2005-62 on page
443 of (IRB) 2005-35 at
www.irs.gov/irb/2005-35_IRB/ar18.html.
• Notice 2005-80. You can find Notice 2005-80 on page
953 of (IRB) 2005-46 at
www.irs.gov/irb/2005-46_IRB/ar14.html.
• Notice 2006-92. You can find Notice 2006-92 on page
774 of (IRB) 2006-43 at
www.irs.gov/irb/2006-43_IRB/ar14.html.
• Notice 2007-37. You can find Notice 2007-37 on page
1002 of (IRB) 2007-17 at
www.irs.gov/irb/2007-17_IRB/ar13.html.
• Notice 2007-97. You can find Notice 2007-97 on page
1092 of (IRB) 2007-49 at
www.irs.gov/irb/2007-49_IRB/ar12.html.

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.

Cat. No. 48249T

No.

Including the Fuel Tax Credit in Income

Type of Use

You must include in your gross income the amount of the
credit from line 17 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.

4

In a boat engaged in commercial fishing

5

In certain intercity and local buses

6

In a qualified local bus

7

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

Specific Instructions

8

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)

9

In foreign trade

10

Certain helicopter and fixed-wing aircraft uses

11

Exclusive use by a qualified blood collector
organization

12

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

13

Exclusive use by a nonprofit educational
organization

14

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

15

In an aircraft or vehicle owned by an aircraft
museum

16

In military aircraft

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, the number of gallons or gasoline
gallon equivalents (GGE) (compressed natural gas
(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.
Amount of credit. Generally, multiply the rate by the
number of gallons. For lines 9 and 10, enter the number
of gallons of alcohol or biodiesel/renewable diesel. For
lines 11 and 12, 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.
Exported taxable fuel. The claim rates for exported
taxable fuel are listed on lines 1d, 2c, 3e, 4d, 14b, 16a,
and 16b. 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 actual 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.

Types 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 13.
Registered Credit Card Issuers on page 6.
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.

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.

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

Type of Use

1

On a farm for farming purposes

2

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

3

Export

An income tax credit for gasoline and aviation
gasoline can be claimed on Form 4136 by the
CAUTION ultimate purchaser 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.

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Instructions for Form 4136 (2011)

Line 1. Nontaxable Use of Gasoline

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 5. For line 4c, the claimant has not waived the
right to make a claim. See Types of use 13 and 14 on
page 2. Type of use 8 includes use as heating oil and
use in a motorboat.

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 types of use 4, 5, 7, 11, 13, 14, or
15. For types of use 13 or 14, claimant has not waived
the right to make a claim. See Types of use 13 and 14 on
page 2.
For line 1d, the gasoline must have been exported
during the period of claim (type of use 3). See Exported
taxable fuel on page 2.

For line 4d, the kerosene must have been exported
during the period of claim (type of use 3). See Exported
taxable fuel on page 2.
For lines 4e and 4f, the kerosene must have been
used during the period of claim for type of use 2.
You may claim a credit for the tax on undyed
TIP kerosene you purchased (other than from a
blocked pump) and used in your home during
2011 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 17 of Form 4136, and
b. Line 70 of Form 1040.

Line 2. Nontaxable Use of Aviation Gasoline

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The credit rates for lines 2a, 2b, and 2c may
change after January 31, 2012.

Line 5. Kerosene Used in Aviation

CAUTION

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 types of
use 1, 2, 9, 10, 11, 13, 14, or 15. For types of use 13 or
14, claimant has not waived the right to make a claim.
See Types of use 13 and 14 on page 2.
For line 2c, the aviation gasoline must have been
exported during the period of claim (type of use 3). See
Exported taxable fuel on page 2.
For line 2d, the aviation fuel must have been used in
foreign trade to claim a credit for the LUST tax paid (type
of use 9).

!

CAUTION

Claimant. For lines 5a and 5b, the ultimate purchaser
of kerosene used in commercial aviation (other than
foreign trade) is eligible to make this claim. For lines 5c,
5d, and 5e, the ultimate purchaser of kerosene used in
noncommercial aviation (other than nonexempt,
noncommercial aviation and exclusive use by a state,
political subdivision of a state, or the District of Columbia)
is eligible to make this claim. Claimant certifies that the
right to make the claim has not been waived.
Allowable uses. For lines 5a and 5b, the kerosene
must have been used during the period of claim in
noncommercial aviation. 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).
For lines 5c and 5d, the kerosene must have been
used during the period of claim for types of use 1, 9, 10,
11, 13, 15, or 16.
For line 5e, the kerosene must have been used during
the period of claim for type of use 9. This claim is made
in addition to the claim made on lines 5c and 5d for type
of use 9.

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 types 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 Types of use 13
and 14 on page 2. 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 on page 2.

Line 4. Nontaxable Use of Undyed Kerosene
(Other Than Kerosene Used in Aviation)

Information for Claims on Lines 6–8
Registration number. To make an ultimate vendor
claim on lines 6–8 you must be registered. Enter your
registration number, including the prefix, on the

Claimant. The ultimate purchaser of the kerosene is the
only person eligible to make this claim.
Instructions for Form 4136 (2011)

The credit rates for lines 5b and 5d may change
after January 31, 2012.

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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.

applicable line for your claim. If you are not registered,
use Form 637, Application for Registration (For Certain
Excise Tax Activities), to register.
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.

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

Line 6a. Sales by Registered Ultimate Vendors
of Undyed Diesel Fuel

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.

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).

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

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.

The credit rate for line 8a may change after
January 31, 2012.

CAUTION

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

Lines 8c, 8d, 8e, and 8f. Sales By Registered
Ultimate Vendors of Kerosene Sold For Use in
Noncommercial Aviation

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

!

The credit rates for lines 8c and 8e may change
after January 31, 2012.

CAUTION

Claimant. For line 8c, the registered ultimate vendor of
the kerosene sold for use in nonexempt, noncommercial
aviation is the only person eligible to make this claim and
has obtained the required certificate from the ultimate
purchaser. See Model Certificate Q in Pub. 510. For lines
8d, 8e, and 8f, the registered ultimate vendor of the
kerosene sold for nontaxable use in noncommercial
aviation (foreign trade for line 8f) is eligible to make this
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 L 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

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.
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Instructions for Form 4136 (2011)

aviation. For lines 8d and 8e, the kerosene sold for use in
noncommercial aviation must have been sold during the
period of claim for types of use 1, 9, 10, 11, 13, 14, 15, or
16.

additives under section 211 of the Clean Air Act.
Renewable diesel fuel also includes fuel derived from
biomass that meets a Department of Defense
specification for military jet fuel or an ASTM specification
for aviation turbine fuel. For a renewable diesel mixture
used in aviation, kerosene is treated as if it is diesel fuel.

For line 8f, the kerosene sold for use in
noncommercial aviation must have been sold during the
period of claim for type of use 9. This claim is made in
addition to the claim made on lines 8d and 8e for type of
use 9.
Registration number. Enter your UA (UV if type of use
14) registration number in the space provided.

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. For the renewable diesel mixture
credit, you must edit the certificate and, if applicable,
statement to indicate that the fuel to which the certificate
and statement relate is renewable diesel and state the
renewable diesel meets the requirements discussed
above under Claimant. See 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
or renewable diesel, attach a separate sheet with the
following information.
1. Certificate identification number.
2. Total gallons of biodiesel or renewable diesel on
certificate.
3. Total gallons claimed on Schedule 3 (Form 8849).
4. Total gallons claimed on Schedule C (Form 720),
line 13.

Information for Claims on Lines 9, 10, and 12
The alcohol fuel mixture credit, biodiesel or renewable
diesel mixture credit, alternative fuel credit, and
alternative fuel mixture credit must first be taken on
Schedule C (Form 720) to reduce your tax liability for
diesel fuel and special motor fuels reported on Form 720.
If you did not make these claims on Schedule C (Form
720), you must make them on Form 720X, Amended
Quarterly Federal Excise Tax Return, before making
them on Form 4136.

Line 9. Alcohol Fuel Mixture Credit

!

The credits on lines 9a and 9b are scheduled to
expire on December 31, 2011.

CAUTION

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 9.
How to claim the credit. Any alcohol 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),
Schedule 3 (Form 8849), Form 4136, or Form 6478. See
Notice 2005-4 and Notice 2005-62 for more information.

Registration number. If you are a registered blender or
a taxable fuel registrant, enter your registration number,
including the prefix, on line 10.
How to claim the credit. Any biodiesel or renewable
diesel 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), Schedule 3 (Form 8849), Form
4136, or Form 8864. See Notice 2005-4 and Notice
2005-62 for more information.

Line 11. Nontaxable Use of Alternative Fuel
Claimant. The ultimate purchaser of the taxed
alternative fuel is the only person eligible to make this
claim.

Line 10. Biodiesel or Renewable Diesel Mixture
Credit

!

Allowable uses. The alternative fuel must have been
used during the period of claim for types of use 1, 2, 4, 5,
6, 7, 11, 13, 14, or 15.

The credits on lines 10a, 10b, and 10c are
scheduled to expire on December 31, 2011.

Type of use 5. Write “Bus” in the space to the left of
column (a). Enter the correct credit rate in column (b).
The credit rates for type of use 5 are listed below.

CAUTION

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 meet the Environmental
Protection Agency’s (EPA) registration requirements for
fuels and fuel additives under section 211 of the Clean
Air Act. The renewable diesel used to produce the
renewable diesel mixture must be a liquid fuel derived
from biomass, meet ASTM D975, D396, or other
equivalent standard approved by the IRS, and meet
EPA’s registration requirements for fuels and fuel
Instructions for Form 4136 (2011)

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Line number

Credit rate

11a

$.109

11b

.110

11c

.109*

11d

.110

11e

.17

11f

.17

Line number

Credit rate

11g

.169

11h

.110

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.

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

Line 12. Alternative Fuel Credit and Alternative
Fuel Mixture Credit

!

CAUTION

The credits on lines 12a, 12b, 12c, 12e, 12f, 12g,
12h, and 12i (except liquefied hydrogen) are
scheduled to expire on December 31, 2011.

For line 13c, if the kerosene was taxed at $.244,
the credit rate is $.243. Write “Taxed at $.244” in
CAUTION the space to the left of column (b). Enter $.243 in
column (b).

Claimant. For the alternative fuel credit, the registered
alternative fueler who (1) sold an alternative fuel at retail
and delivered it into the fuel supply tank of a motor
vehicle or motorboat, (2) sold an alternative fuel,
delivered it in bulk for taxable use in a motor vehicle or
motorboat, and received the required statement from the
buyer, (3) used an alternative fuel (not sold at retail or in
bulk as previously described) in a motor vehicle or
motorboat, or (4) sold an alternative fuel for use as a fuel
in aviation is the only person eligible to make this claim.
For the alternative fuel mixture credit, the registered
alternative fueler that produced and sold or used the
mixture as a fuel 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 alternative fuel
credit and alternative fuel mixture credit may be taken on
Schedule C (Form 720), Schedule 3 (Form 8849), or
Form 4136.

!

Line 14. 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 14a, the diesel-water fuel
emulsion must have been used during the period of claim
for types of use 1, 2, 5, 6, 7, 8, 11, 13, 14, or 15. For line
14b, 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 rate in column (b).
The credit rate for type of use 5 is $.124 per gallon.

Line 15. 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 with the EPA under section 211 of the
Clean Air Act,
• 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.

Line 13. Registered Credit Card Issuers

!

The credit rate for line 13c may change after
January 31, 2012.

CAUTION

Claimant. The registered credit card issuer is the only
person eligible to make this claim if the credit card issuer:
• Is registered by the IRS;
• 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;
• 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
• 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.

Line 16. 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.

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Instructions for Form 4136 (2011)

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: Recordkeeping, 34 hr., 55 min.; Learning about the
law or the form, 36 min.; Preparing, copying,
assembling, and sending the form to the IRS, 1 hr., 12
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.

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

Instructions for Form 4136 (2011)

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