Form 4136 Credit for Federal Tax Paid on Fuels

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Form

4136

Department of the Treasury
Internal Revenue Service (99)

Credit for Federal Tax Paid on Fuels
▶

OMB No. 1545-0162

2019

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)

DRAFT AS OF
}
October 1, 2019
DO NOT FILE

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

Note: CRN is credit reference number.

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

(c) Gallons

(d) Amount of credit

(e) CRN

$ .183
.183

Other nontaxable use (see Caution above line 1)
Exported

362

.183
.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
LUST tax on aviation fuels used in foreign trade

(b) Rate

(c) Gallons

(d) Amount of credit

$ .15
.193
.194
.001

(e) CRN

$

354
324
412
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

a
b
c
d

Nontaxable use
Use on a farm for farming purposes
Use in trains

e

Exported

4

(b) Rate

(c) Gallons

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

(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

(d) Amount of credit

}

$ .243
.243

$

.

.

▶

(e) CRN

346

.17
.244

347
414

.043
.218

377
369
Cat. No. 12625R

Form 4136 (2019)

Page 2

Form 4136 (2019)

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

(e) CRN

(d) Amount of credit

DRAFT AS OF
October 1, 2019
DO NOT FILE
$ .200

$

417

b Kerosene used in commercial aviation (other than
c

foreign trade) taxed at $.219

.175

355

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

.243

346

.218
.001

369
433

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

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

7

(c) Gallons

(d) Amount of credit

$ .243
.17

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

.

.

▶

(e) CRN

$

360
350

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

(c) Gallons

}

$ .243
.243
.17

Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

(d) Amount of credit

$

.

.

▶

(e) CRN

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

a

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

(b) Rate

$ .175

(c) Gallons

(d) Amount of credit

$

(e) CRN

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
LUST tax on aviation fuels used in foreign trade

.200
.025
.243
.218
.001

417
418
346
369
433
Form 4136 (2019)

Page 3

Form 4136 (2019)

9

Reserved for future use

Registration No. ▶
(b) Rate

(c) Gallons
of alcohol

a Reserved for future use
b Reserved for future use

(d) Amount of credit

(e) CRN

$

DRAFT AS OF
October 1, 2019
DO NOT FILE

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 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 10. 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

11

(c) Gallons
of biodiesel or
renewable diesel

$1.00
1.00
1.00

(d) Amount of credit

(e) CRN

388
390
307

$

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

Liquefied petroleum gas (LPG) (see instructions)
“P Series” fuels
Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen
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
12

(b) Rate

$ .183
.183
.183
.183

“P Series” fuels

Compressed natural gas (CNG) (see instructions)
Liquefied hydrogen
Fischer-Tropsch process liquid fuel from coal (including peat)
Liquid fuel derived from biomass
Liquefied natural gas (LNG) (see instructions)
Liquefied gas derived from biomass
Compressed gas derived from biomass

$

419
420
421
422
423
424
425
435

Registration No. ▶
(b) Rate

Liquefied petroleum gas (LPG) (see instructions)

(e) CRN

.243
.243
.243
.183

Alternative Fuel Credit

a
b
c
d
e
f
g
h
i

(d) Amount
of credit

(c) Gallons,
or gasoline
or diesel gallon
equivalents

$ .50
.50
.50
.50
.50
.50
.50
.50
.50

(d) Amount of credit

(c) Gallons, or
gasoline or diesel
gallon equivalents

$

(e) CRN

426
427
428
429
430
431
432
436
437
Form 4136 (2019)

Page 4

Form 4136 (2019)

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

(c) Gallons

$ .243
.243

(d) Amount of credit
$

(e) CRN
360
346

DRAFT AS OF
October 1, 2019
DO NOT FILE
government taxed at $.219

.218

369

Nontaxable Use of a Diesel-Water Fuel Emulsion

14

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 Nontaxable use
b Exported

15

(b) Rate
$ .197
.198

Diesel-Water Fuel Emulsion Blending

16

(d) Amount of credit

$

(e) CRN
309
306

Registration No. ▶

(b) Rate

Blender credit

(c) Gallons

(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
.001

Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on
Schedule 3 (Form 1040 or 1040-SR), line 12; Form 1120, Schedule J, line 20b; Form 1120-S,
line 23c; Form 1041, Schedule G, line 16b; or the proper line of other returns . . . . ▶

(d) Amount of credit

$

(e) CRN

415
416

17 $
Form 4136 (2019)