OMB No. 1545-0162 Credit for Federal Tax Paid on Fuels

Form 4136

Department of the Treasury

Internal Revenue Service

Attachment

 Attach this form to your income tax return. Sequence No. 23

Name (as shown on your income tax return) Taxpayer identification number

Cat. No. 12625R Form 4136 (1999)

2 Nontaxable Use of Aviation Gasoline

312

10% gasohol

7.7% gasohol

5.7% gasohol

Nontaxable Use of Gasoline and Gasohol

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Off-highway business use of gasoline $

1

(e)

CRN

301

3 Nontaxable Use of Undyed Diesel Fuel and Undyed Kerosene

Use of gasoline on a farm for farming purposes

e

d

f

a

b

c

(99)

Other nontaxable use of gasoline

 See the Instructions for Form 4136.

(a) Type

of use

Claimant certifies that the fuel did not contain visible evidence of dye.

Exception. If any of the fuel included in this claim did contain visible evidence of dye, attach a detailed explanation and check here 

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

For Paperwork Reduction Act Notice, see the instructions.

(b)

Rate

(c)

Gallons

(d)

Amount of credit

Use in commercial aviation (other than foreign trade) $

(e)

CRN

307

Other nontaxable use

a

b

(a) Type

of use

Claimant has the name and address of the person(s) who sold the fuel to the claimant and the date(s) of the purchase(s) and if exported,

the required proof of export.

Caution: Claims cannot be made on line 3 for fuel used on a

farm for farming purposes or for kerosene sold from a blocked

pump. Only registered ultimate vendors may make those claims.

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

Use in certain intercity and local buses

a

b

c

Use in trains

303

305

$

4 Nontaxable Use of Aviation Fuel (other than gasoline)

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in commercial aviation (other than foreign trade)

310

Other nontaxable use

a

b

$

$

$

$









303

$



.184

.184

.184

.184

.13

.14242

.15322

.15

.194

.194

.244

.244

.20

.17

.175

.219

.219

1999
$

Form 4136 (1999) Page 2

9

9 Total income tax credit claimed. Add lines 1 through 8. Enter here and on Form 1040,

line 63 (also check box b on line 63); Form 1120, line 32g; Form 1120-A, line 28g; Form

1120S, line 23c; Form 1041, line 24g; or the proper line of other returns 

5 Sales by Registered Ultimate Vendors 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 a detailed explanation and check here 

Claimant sold the fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer to

take the claim; and obtained the required certificate from the buyer and has no reason to believe any information in the certificate is

false.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes 303

Use by a state or local government

a

b

$

$

6 Sales by Registered Ultimate Vendors of Undyed Kerosene

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 

Claimant sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written consent of the buyer

to take the claim; and obtained the required certificate (for lines 6a and 6b) from the buyer and has no reason to believe any information

in the certificate is false.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes

303

Use by a state or local government

a

b

$

$

c Sales from a blocked pump

7 Nontaxable Use of Liquefied Petroleum Gas (LPG) in Certain Buses

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in certain intercity and local buses 304

Use in qualified local and school buses

a

b

$

$

8 Gasohol Blending

Claimant bought gasoline taxed at the full rate and blended it with alcohol to make gasohol. The gasohol was used or sold for use in

a trade or business. For each batch of gasohol, claimant has the required information relating to the purchase of the gasoline and

alcohol used to make the gasohol and to support the amount claimed.

(a)

Rate (b)

Gasoline

(d)

Amount of credit

(col. (a)  col. (b))

(e)

CRN

10% gasohol

302

7.7% gasohol

a

b

$

$

c 5.7% gasohol

(c)

Alcohol

Gallons of









UP Registration No. 

.244

.244

.244

.244

.244

.062

.136

.03956

.0297

.02152

Form 4136 (1999)
Form 4136 (1999) Page 3

Reporting Fuel Tax Credit in Income

Purpose of Form

Specific Instructions

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.

Recordkeeping

Use Form 4136 to claim a credit for the Federal excise tax

on fuels sold or used for nontaxable uses during the income

tax year. However, you may use Form 8849, Claim for

Refund of Excise Taxes, to claim a periodic refund of excise

taxes instead of waiting to claim an annual credit on Form

4136.

You must include in your gross income the amount of the

credit from line 9 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. 378 for more

information.

Instructions for Form 4136

● Pub. 378, Fuel Tax Credits and Refunds, has more

information on nontaxable uses.

● Pub. 225, Farmer’s Tax Guide, also includes information

on credits for Federal excise tax on fuels.

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, Credits, Deductions, 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, and

the nontaxable use or sale.

No. Type of Use

1 On a farm for farming purposes

2

3 Export

4 In a boat engaged in commercial fishing

5

6

In certain intercity and local buses

7

For diesel fuel, kerosene, and LPG in a qualified local

bus

8

In a bus transporting students and employees of

schools

9

For diesel fuel and kerosene used other than as a fuel

in the propulsion engine of a train or diesel-powered

highway vehicle (but not off-highway business use)

In foreign trade

10 Certain helicopter and fixed-wing air ambulance uses

For aviation fuel used other than as a fuel in the

propulsion engine of an aircraft

11

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. For lines 1 through 7, multiply the rate by

the number of gallons. For line 8, multiply the rate by the

number of gallons of gasoline. Enter the combined result as

indicated by the brackets in the amount of credit column

including amounts on any continuation sheets.

Line 1—Nontaxable Use of Gasoline and Gasohol

Claimant. The ultimate purchaser of the gasoline or gasohol

is the only person eligible to make this claim.

Allowable uses. For line 1a, the gasoline must have been

used during the income tax year for a business use other

than in a highway vehicle registered (or required to be

registered) for highway use (Type of use 2). You cannot claim

a credit for personal use of the fuel or any use in a

motorboat.

For line 1b, the gasoline must have been used during the

income tax year on a farm for farming purposes (Type of use

1). You cannot claim a credit for personal use of the fuel.

For line 1c, the gasoline must have been used during the

income tax year for one or more of the following uses from

the Type of Use Table: 3, 4, 5, and 7.

Section references are to the Internal Revenue Code.

Amending Your Fuel Tax Credit

Generally, you may not amend a previously filed Form 4136

to add to amounts already claimed. See Pub. 378, Fuel Tax

Credits and Refunds, for rules explaining when you may

amend your income tax return to claim other fuel tax credits.

Off-highway business use (for business use other than

in a highway vehicle registered or required to be

registered for highway use)

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 income tax year for one or more of the

following uses from the Type of Use Table: 1, 3, 9, and 10.

Line 3—Nontaxable Use of Undyed Diesel Fuel and

Undyed Kerosene

Claimant. The ultimate purchaser of the fuel is the only

person eligible to make this claim.

For lines 1d–1f, the gasohol must have been used during

the income tax year for one or more of the following uses

from the Type of Use Table: 1, 2, 3, 4, 5, and 7. You cannot

claim a credit for personal use of the fuel or any use in a

motorboat.

Complete and attach all information requested for each

claim you make. Generally, you must enter the number (when

requested) from the Type of Use Table, the number of

gallons, and the amount of credit. If you need more space for

any line (for example, for more types of use), prepare a

continuation sheet using the same format as the line.

Additional Information

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.

Allowable uses. For line 3a, the fuel must have been used

during the income tax year for one or more of the following

uses from the Type of Use Table: 2, 3, 6, 7, and 8. No. 8

includes use as heating oil and use in a boat.

Caution: Line 3 cannot be used to make a claim for fuel

used on a farm for farming purposes or for kerosene sold

from a blocked pump. Only registered ultimate vendors may

make those claims.
Form 4136 (1999) Page 4

Paperwork Reduction Act Notice. We ask for the

information on this form 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.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Recordkeeping, 15 hr., 46 min.; Learning

about the law or the form, 18 min.; Preparing and sending

the form to the IRS, 34 min.

If you have comments concerning the accuracy of these

time estimates or suggestions for making this form 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 this form is filed.

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.

Kerosene uses. Report each kerosene type of use

separately on line 3a. Write a “K” in the space to the left of

column (a), and the number of gallons of kerosene in column

(c). If more than two uses, attach a continuation sheet.

Line 4—Nontaxable Use of Aviation Fuel (other than

gasoline)

Claimant. The ultimate purchaser of the aviation fuel is the

only person eligible to make this claim.

Allowable uses. For line 4b, the aviation fuel must have

been used during the income tax year for one or more of the

following uses from the Type of Use Table: 1, 3, 9, 10,

and 11.

Line 5—Sales by Registered Ultimate Vendors of

Undyed Diesel Fuel

Claimant. The registered ultimate vendor of the diesel fuel is

the only person eligible to make this claim.

Allowable sales. The fuel must have been sold during the

income tax year for:

● Use on a farm for farming purposes, or

● Use by a state or local government (including essential

government use by an Indian tribal government).

Information to be submitted. Attach a separate sheet with

the name and TIN of each farmer, custom harvester, or

governmental unit to whom the diesel fuel was sold and the

number of gallons sold to each.

Line 6—Sales by Registered Ultimate Vendors of

Undyed Kerosene

Claimant. The registered ultimate vendor of the kerosene is

the only person eligible to make this claim.

● For use by a state or local government (including essential

government use by an Indian tribal government), or

● From a blocked pump. A separate UP registration number

must be entered for these sales on line 6. If you do not have

a UP registration number, you cannot make this claim. Get

Form 637, Application for Registration (For Certain Excise

Tax Activities), to apply for one. See your income tax return

instructions for information on how to get tax forms.

Information to be submitted. For lines 6a and 6b, attach a

separate sheet with the name and TIN of each farmer,

custom harvester, or governmental unit to whom the

kerosene was sold and the number of gallons sold to each.

Line 7—Nontaxable Use of Liquefied Petroleum Gas

(LPG) in Certain Buses

Claimant. The ultimate purchaser of the LPG (such as

propane or butane) is the only person eligible to make this

claim.

Line 8—Gasohol Blending

Claimant. The person that produced the gasohol is the only

person eligible to make this claim.

Allowable uses. For line 7a, the LPG must have been used

during the income tax year in an intercity or local bus (Type

of use 5).

For line 7b, the LPG must have been used during the

income tax year in a qualified local bus (Type of use 6) or a

bus transporting students and employees of schools (Type of

use 7).

To claim the credit on line 3a for home use:

1. Enter K in the space to the left of col. (a).

2. Enter 8 in col. (a).

3. Enter the number of gallons of kerosene in col. (c).

4. Multiply the gallons in col. (c) by $.244. Enter the result in

col. (d).

5. If this is the only fuel tax credit you are claiming, enter the

amount from col. (d) on:

● Line 9 of Form 4136, and

● Line 63 of Form 1040. Also, check box b on line 63.

You may claim a credit for the tax on undyed

kerosene you purchased (other than from a

blocked pump) and used in your home during

1999 for heating, lighting, or cooking.

Allowable sales. The fuel must have been sold during the

income tax year:

● For use on a farm for farming purposes,