U.S. Individual Income Tax Return Forms

2019

Instructions for Form 4136

Department of the Treasury
Internal Revenue Service

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

sale, and any additional information required to be
submitted.

Future Developments

Additional Information

For the latest information about developments related to
Form 4136 and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
Form4136.

What’s New
How to claim biodiesel or renewable diesel mixture
credit or alternative fuel credit. For 2019, the biodiesel
or renewable diesel mixture credit and the alternative fuel
credit are extended. You can use Form 4136 to claim the
credit for mixtures or fuels sold or used during the 2019
calendar year. To find out if you can use Schedule 3
(Form 8849) to claim the credit, go to IRS.gov/Form4136.

General Instructions
Purpose of Form

Use Form 4136 to claim the following.
• The biodiesel or renewable diesel mixture credit.
• The alternative fuel credit.
• A credit for certain nontaxable uses (or sales) of fuel
during your income tax year.
• A credit for blending a diesel-water fuel emulsion.
• A credit for exporting dyed fuels or gasoline
blendstocks.
Attach Form 4136 to your tax return.
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 excise tax liability.

• Pub. 510, Excise Taxes.
• Pub. 225, Farmer's Tax Guide.
• Notice 2005-4 (alcohol and biodiesel fuels; off-highway

vehicles; aviation-grade kerosene; diesel fuel in buses;
displaying registration on vessels; sales of gasoline to
states, towns, and educational nonprofits; two-party
exchanges of taxable fuel; and classifying transmix and
diesel fuel blendstocks as diesel fuel). You can find Notice
2005-4 on page 289 of I.R.B. 2005-2 at
IRS.gov/IRB/2005–02 IRB#NOT-2005–4.
• Notice 2005-62 (certificates for biodiesel,
aviation-grade or nontaxable use kerosene); page 443 of
I.R.B. 2005-35 at IRS.gov/IRB/2005–35 IRB#NOT-2005–
62.
• Notice 2005-80 (LUST tax, treatment of kerosene for
use in aviation, credit card sales of taxable fuel to exempt
entities, diesel-water fuel emulsions, mechanical dye
injection of diesel fuel and kerosene); page 953 of I.R.B.
2005-46 at IRS.gov/IRB/2005–46 IRB/#NOT-2005–80.
• Notice 2006-92 (alternative fuels and alternative fuel
mixtures); page 774 of I.R.B. 2006-43 at
IRS.gov/IRB/2006–43 IRB#NOT-2006–92.
• Notice 2007-97 (alternative fuel and alternative fuel
mixtures defined). 2007-49 I.R.B. 1092, at IRS.gov/IRB/
2007–47 IRB#NOT-2007–97.
• Notice 2008-110 (biodiesel and cellulosic biofuel),
2008-51 I.R.B. 1298, at IRS.gov/IRB/2008–51
IRB#NOT-2008–110.
• Notice 2010-68 (Alaska dyed diesel exemption), Notice
2010-44 I.R.B. 576, at IRS.gov/IRB/2010–44
IRB#NOT-2010–68.

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.

You can’t claim any amounts on Form 4136 that
you claimed on Form 8849 or Form 720,
CAUTION Schedule C. If you report a tax liability on Form
720, you may be required to offset your tax liability with
any credits you claim before claiming a credit on Form
4136 or a refund on Form 8849.

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.

Form 4136 can’t be used by ultimate vendors to make
gasoline claims.

Specific Instructions

!

Partnerships. Partnerships (other than electing large
partnerships) can’t file this form. Instead, they must
include a statement on Schedule K-1 (Form 1065)
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
Jan 03, 2020

Including the Fuel Tax Credit in Income

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
or diesel gallon equivalents (GGE or DGE) (compressed

Cat. No. 48249T

natural gas (CNG), liquefied petroleum gas (LPG), and
liquefied natural gas (LNG) only), and the amount of
credit. If you need more space for any line (for example,
for more types of use), prepare a separate statement
using the same format as the line.

No.

Attach a separate statement showing any additional
information required for your claim, such as the
computation of the amount to be credited. Write your
name and taxpayer identification number (TIN) on each
statement.
Amount of credit. Generally, multiply the rate by the
number of gallons. For lines 11 and 12, enter the number
of gallons, or gasoline or diesel gallon equivalents (CNG,
LPG, and LNG only). Enter the result (or the combined
result as indicated by the brackets) in the Amount of credit
column. Include amounts from any separate statement.
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 keep proof of exportation with their records.
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.

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.

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

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)

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 isn’t 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

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 (or nonprofit educational
organization for gasoline or aviation gasoline) must be
made in the following order.
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, later. If the credit card
issuer isn’t registered, only the ultimate purchaser may
make this claim.
2. By the registered ultimate vendor if the ultimate
purchaser didn’t use a credit card and waives their right to
make the claim and the registered credit card issuer can’t
make the claim.
Additional requirements that must be met are in Pub.
510.

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Instructions for Form 4136 (2019)

For line 3e, the diesel fuel must have been exported
during the period of claim (type of use 3). See Exported
taxable fuel, earlier.

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 Form 8849 or Form 720, Schedule C.

!

Line 4. Nontaxable Use of Undyed Kerosene
(Other Than Kerosene Used in Aviation)
Claimant. The ultimate purchaser of the kerosene is the
only person eligible to make this claim.

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 doesn’t include claims for
kerosene used in aviation for farming purposes; instead,
see Line 5. Kerosene Used in Aviation below. For line 4c,
the claimant must not have waived the right to make a
claim. See Types of use 13 and 14, earlier. Type of use 8
includes use as heating oil and use in a motorboat.
For line 4d, the kerosene must have been exported
during the period of claim (type of use 3). See Exported
taxable fuel, earlier.
For lines 4e and 4f, the kerosene must have been used
during the period of claim for type of use 2.

Claimant. The ultimate purchaser of the gasoline is the
only person eligible to make this claim.
Allowable uses. A claim can’t be made for personal use
of any fuel on line 1. Also, for lines 1a and 1c, a claim can’t
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 type of use 4, 5, 7, 11, 13, 14, or
15. For type of use 13 or 14, the claimant must not have
waived the right to make a claim. See Types of use 13
and 14, earlier.
For line 1d, the gasoline must have been exported
during the period of claim (type of use 3). See Exported
taxable fuel, earlier.

You can claim a credit for the tax on undyed

TIP kerosene you purchased (other than from a

blocked pump) and used in your home during
2015 for heating, lighting, or cooking.
To claim the credit on line 4a for home use, complete
the following steps.
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. Form 4136, line 17; and
b. Schedule 3, Form 1040 (or 1040-SR), line 12.

Line 2. Nontaxable Use of Aviation Gasoline
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 type of use
1, 2, 9, 10, 11, 13, 14, or 15. For type of use 13 or 14, the
claimant must not have waived the right to make a claim.
See Types of use 13 and 14, earlier.
Use line 2b to make a claim for aviation gasoline used
outside the propulsion system of an aircraft.
For line 2c, the aviation gasoline must have been
exported during the period of claim (type of use 3). See
Exported taxable fuel, earlier.
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).

Line 5. Kerosene Used in Aviation
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. By making this claim, the
claimant is certifying that it hasn’t waived the right to make
the claim.

Line 3. Nontaxable Use of Undyed Diesel Fuel

Allowable uses. For lines 5a and 5b, the kerosene must
have been used during the period of claim in commercial
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 type of use 1, 9, 11, 10, 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

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 type of use 2, 6,
7, 8, 11, 13, 14, or 15. For line 3d, the claimant must not
have waived the right to make a claim. See Types of use
13 and 14, earlier. Type of use 8 includes use as heating
oil and use in a motorboat.
Instructions for Form 4136 (2019)

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claimant must have 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.

addition to the claim made on lines 5c and 5d for type of
use 9. Depending on the tax rate of the kerosene, use
line 4a, 4e, or 4f to make a claim for kerosene used
outside the propulsion system of an aircraft.

Information for Claims on Lines 6–8

Allowable sales. The fuel must have been sold during
the period of claim:
• For line 7a, for 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. To make an ultimate vendor claim
on lines 6–8, you must be registered. Enter your
registration number, including the prefix, on the applicable
line for your claim. If you aren’t registered, use Form 637
to register.

Registration number. Enter your UV or UP registration
number in the space provided.

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.

Information to be submitted. For claims on line 7a,
attach a separate statement with the name and TIN of
each governmental unit to whom the kerosene was sold
and the number of gallons sold to each.

Line 6a. Sales by Registered Ultimate Vendors of
Undyed Diesel Fuel for Use by a State or Local
Government

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

Claimant. For line 6a, the registered ultimate vendor of
the diesel fuel is the only person eligible to make this
claim. The registered ultimate vendor must have obtained
the required certificate from the buyer and must have 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.

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.

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).

Registration number. Enter your UB registration
number in the space provided.

Registration number. Enter your UV registration
number in the space provided.

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

Information to be submitted. For claims on line 6a,
attach a separate statement with the name and TIN of
each governmental unit to whom the diesel fuel was sold
and the number of gallons sold to each.

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.

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.

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.

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 8c, the registered ultimate vendor of
the kerosene sold for use in nonexempt, noncommercial
aviation is the only person eligible to make this claim. The
registered ultimate vendor must have 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

Claimant. For line 7a, the registered ultimate vendor of
the kerosene is the only person eligible to make this claim.
The registered ultimate vendor must have obtained the
required certificate from the buyer and must have no
reason to believe any information in the certificate is false.
See Model Certificate P in Pub. 510. For line 7b, the
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Instructions for Form 4136 (2019)

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 Form 720, Schedule C,
line 12.

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.

Registration number. If you are a registered blender or
a taxable fuel registrant, enter your registration number,
including the prefix, on line 10.

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

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.
Allowable uses. The alternative fuel must have been
used during the period of claim for type of use 1, 2, 4, 5, 6,
7, 11, 13, 14, or 15.
Type of use 5. Write “Bus” in the space to the left of
column (a). Enter the correct claim rate in column (b). The
claim rates for type of use 5 are listed below.

Registration number. Enter your UA (UV if type of use
14) registration number in the space provided.

Line 9
Line 9 is reserved for future use.

Line number

Claim rate

11a

$.109*

Line 10, Biodiesel or Renewable Diesel Mixture
Credit

11b

.110

11c

  .109**

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 the EPA's registration
requirements for fuels and fuel 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.

11d

.110

11e

  .17  
.17  
.169***

11h

.110

For sales or uses of fuel after December 31, 2015: (*) This is the claim rate per
GGE (5.75 pounds or 1.353 gallons of LPG); (**) This is the claim rate per GGE
(5.66 pounds or 123.57 cubic ft. of CNG); (***) This is the claim rate per DGE (6.06
pounds or 1.71 gallons of LNG)

Type of use 5 example. 10,000 gallons of LPG ÷ 1.353
= 7,391 GGE x $0.109 = $805.62 claim amount.

Line 12. Alternative Fuel Credit

!

The alternative fuel mixture credit can’t be claimed
on this form.

CAUTION

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 Statement S in Pub. 510. If the certificate and
statement aren’t attached to Form 4136 because they’re
attached to a previously filed claim on Schedule 3 (Form
8849) or Form 720, Schedule C, for the biodiesel or
renewable diesel credit, attach a separate statement with
the following information.
Instructions for Form 4136 (2019)

11f
11g

Claim rates.
• CNG has a claim rate (or GGE) of 121 cubic feet.
• Compressed gas derived from biomass has a claim rate
(or GGE) of 121 cubic feet.
For sales or uses of fuel after December 31, 2015:
• LPG has a claim rate (or GGE) of 5.75 pounds or 1.353
gallons of LPG, and
• LNG has a claim rate (or DGE) of 6.06 pounds or 1.71
gallons of LNG.
Example. 10,000 gallons of LNG ÷ 1.71 = 5,848 DGE
x $0.50 = $2,924 claim amount.
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
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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.

exported during the period of claim (type of use 3). See
Exported taxable fuel, earlier.
Type of use 5. Write “Bus” in the space to the left of
column (a). Enter the correct claim rate in column (b). The
claim rate for type of use 5 is $.124 per gallon.

Registration number. You must enter your registration
number, including the prefix, in the space provided.

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.

Line 15. Diesel-Water Fuel Emulsion Blending

How to claim the credit. Any alternative fuel credit and
alternative fuel mixture credit must first be taken on Form
720, Schedule C, to reduce your taxable fuel liability
reported on Form 720. Any excess alternative fuel credit
may be taken on Form 720, Schedule C; Form 4136; or
Schedule 3 (Form 8849).

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 U.S.
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
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;
• Hasn’t 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.
If any of these conditions isn’t met, the credit card
issuer must collect the tax from the ultimate purchaser
and only the ultimate purchaser can make the claim.

Line 16. Exported Dyed Fuel and Exported
Gasoline Blendstocks
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, earlier.
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.

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).

You aren’t 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.

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

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
burden for individual taxpayers filing this form is approved
under OMB control number 1545-0074 and is included in
the estimates shown in the Instructions for Form 1040 or
1040-SR. The estimated burden for all other taxpayers is:
Recordkeeping, 36 hr., 56 min.; Learning about the
law or the form, 30 min.; Preparing, copying,
assembling, and sending the form to the IRS, 59 min.

!

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.

If you have comments concerning the accuracy of
these time estimates or suggestions for making Form
4136 simpler, we’d be happy to hear from you. You can
write to us at the address listed in the instructions of the
tax return with which Form 4136 is filed.

Allowable uses. For line 14a, the diesel-water fuel
emulsion must have been used during the period of claim
for type of use 1, 2, 5, 6, 7, 8, 11, 13, 14, or 15. For
line 14b, the diesel-water fuel emulsion must have been

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Instructions for Form 4136 (2019)