Form 4136 Form 4136 Credit for Federal Tax Paid on Fuels

Form

4136

Department of the Treasury
Internal Revenue Service (99)

Credit for Federal Tax Paid on Fuels
▶

OMB No. 1545-0162

2018

Go to www.irs.gov/Form4136 for instructions and the latest information.

Attachment
Sequence No. 23

Taxpayer identification number

Name (as shown on your income tax return)

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 or 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 or 14), claimant certifies that a certificate has not been provided to the
credit card issuer.
1

Nontaxable Use of Gasoline

Note: CRN is credit reference number.
(a) Type of use

a
b
c
d

2

(b) Rate

(c) Gallons

Off-highway business use
Use on a farm for farming purposes
Other nontaxable use (see Caution above line 1)
Exported

}

(d) Amount of credit

(e) CRN
362

$

Nontaxable Use of Aviation Gasoline
(a) Type of use

a
b
c
d

3

(b) Rate

(c) Gallons

(d) Amount of credit

Use in commercial aviation (other than foreign trade)
Other nontaxable use (see Caution above line 1)
Exported
LUST tax on aviation fuels used in foreign trade

(e) CRN

$

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

e

Exported

4

a
b
c
d

(b) Rate

(c) Gallons

}

(d) Amount of credit

(e) CRN

$

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

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

a Nontaxable use taxed at $.244
b Use on a farm for farming purposes
c Use in certain intercity and local buses (see Caution

}

(d) Amount of credit

(e) CRN

$

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.

Cat. No. 12625R

Form 4136 (2018)

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Form 4136 (2018)

5

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

a

(b) Rate

(c) Gallons

(d) Amount of credit

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

(e) CRN

$

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

6

LUST tax on aviation fuels used in foreign trade

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
(c) Gallons
(d) Amount of credit (e) CRN

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

7

$

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
(c) Gallons
(d) Amount of credit

}

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

(e) CRN

$

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

a

Use in commercial aviation (other than foreign trade) taxed
at $.219

(b) Rate

(c) Gallons

(d) Amount of credit

(e) CRN

$

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
LUST tax on aviation fuels used in foreign trade
Form 4136 (2018)

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Form 4136 (2018)

9

Reserved for future use

Registration No. ▶

(b) Rate

(c) Gallons of
alcohol

a Reserved for future use
b Reserved for future use
10

(e) CRN

$

Reserved for future use

Registration No. ▶

(b) Rate

(c) Gallons of
(d) Amount of credit
biodiesel or
renewable diesel

a Reserved for future use
b Reserved for future use
c Reserved for future use
11

(d) Amount of credit

(e) CRN

$

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).
(a) Type of use

a
b
c
d
e

(b) Rate

(c) Gallons,
or gasoline
or diesel gallon
equivalents

Liquefied petroleum gas (LPG) (see instructions)
“P Series” fuels
Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen

(d) Amount of credit

(e) CRN

(d) Amount of credit

(e) CRN

$

Fischer-Tropsch process liquid fuel from coal (including
peat)

f Liquid fuel derived from biomass
g Liquefied natural gas (LNG) (see instructions)
h Liquefied gas derived from biomass
Reserved for future use

12

Registration No. ▶
(b) Rate

a
b
c
d
e
f
g
h
i

Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use

(c) Gallons,
or gasoline
or diesel gallon
equivalents

$

Form 4136 (2018)

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Form 4136 (2018)

13

Registered Credit Card Issuers

Registration No. ▶
(b) Rate

(c) Gallons

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

14

(d) Amount of credit

(e) CRN

$

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

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 instructions).
(a) Type of use

(b) Rate

15

Diesel-Water Fuel Emulsion Blending

(e) CRN

$

Registration No. ▶
(b) Rate

(c) Gallons

Blender credit

16

(d) Amount of credit

(c) Gallons

a Nontaxable use
b Exported

(d) Amount of credit

(e) CRN

(d) Amount of credit

(e) CRN

$

Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate

(c) Gallons

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

17

Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on
Schedule 5 (Form 1040), line 73; Form 1120, Schedule J, line 20b; Form 1120S, line 23c; Form
1041, line 25h; or the proper line of other returns. ▶

$

17 $
Form 4136 (2018)