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 (2004)

2 Nontaxable Use of Aviation Gasoline

375

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

362

3 Nontaxable Use of Undyed Diesel Fuel

Use of gasoline on a farm for farming purposes

e

d

f

a

b

c Other nontaxable use of gasoline

 See the Instructions on page 3.

(a) Type

of use

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 

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

354

Other nontaxable use

a

b

(a) Type

of use

Claimant has the name and address of the person(s) who sold the diesel 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 diesel fuel used

on a farm for farming purposes. Only registered ultimate

vendors may make those claims (see line 6).

(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

350

353

$

4

$

$

$





360 

.184

.184

.184

.184

.132

.14396

.15436

.15

.194

.194

.244

.244

.20

.17

359

376

324

Nontaxable Use 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 has the name and address of the person(s) who sold the kerosene 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 4 for kerosene used

on a farm for farming purposes or for kerosene sold from a

blocked pump. Only registered ultimate vendors may make

those claims (see line 7).

(b)

Rate

(c)

Gallons

(d)

Amount of credit

$

(e)

CRN

(a) Type

of use

Nontaxable use

$ 346 .244

.244

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

● Sales by gasoline wholesale distributors cannot be claimed on Form 4136. Instead, use Schedule 4 (Form 8849)

or Schedule C, line 11 (Form 720) to make these claims.

2004
$

Form 4136 (2004) Page 2

10

10 Total income tax credit claimed. Add lines 1 through 9, column (d). Enter here and on

Form 1040, line 69 (also check box b on line 69); Form 1120, line 32g; Form 1120-A, line

28g; Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns. 

6 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 diesel 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. See the instructions for additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes 360

Use by a state or local government

a

b

$

$

7 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 7a and 7b) from the buyer and has no reason to believe any information

in the certificate is false, or has the Regulations section 48.6427-10(e)(4) statement, if required, for line 7c. See the instructions for

additional information to be submitted.

UV Registration No. 

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use on a farm for farming purposes

346

Use by a state or local government

a

b

$

$

c Sales from a blocked pump

8 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

352

Use in qualified local buses or school buses

a

b

$

$

9 Gasohol Blending

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

claimant’s 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

357

7.7% gasohol

a

b

$

$

c 5.7% gasohol

(c)

Alcohol

Gallons of





UP Registration No. 

.244

.244

.244

.244

.244

.062

.136

.03734

.02804

.02031

Form 4136 (2004)

Nontaxable Use of Aviation Fuel

(b)

Rate

(c)

Gallons

(d)

Amount of credit

(e)

CRN

(a) Type

of use

Use in commercial aviation (other than foreign trade)

Other nontaxable use 369

a

b

$

$ .175

.219

.044

5

355

377

361

356

363

c Other nontaxable uses
Form 4136 (2004) Page 3

Including the 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 on Form 4136.

Recordkeeping

Use Form 4136 to claim a credit for certain nontaxable uses

(or sales) of fuel during the income tax year. However, you

may use Form 8849, Claim for Refund of Excise Taxes, to

claim a periodic refund 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 10 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

● Publication 378, Fuel Tax Credits and Refunds, has more

information on nontaxable uses and the definitions of terms

such as gasohol blending, ultimate vendor, and blocked

pump.

● Publication 225, Farmer’s Tax Guide, also includes

information on credits for the 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, 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.

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 in a qualified local bus

8

In a bus transporting students and employees of

schools (school buses)

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 8, multiply the rate by

the number of gallons. For line 9, multiply the rate by the

number of gallons of gasoline. Enter the result (or the

combined result as indicated by the brackets) in the amount

of credit column. Include amounts from any separate 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. A claim cannot be made for personal use of

any fuel on line 1. Also, for lines 1a and 1c–1f, a claim

cannot be made for any use in a motorboat, other than

commercial fishing.

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

income tax year 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 3, 4, 5, or 7.

Section references are to the Internal Revenue Code.

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 types of use 1, 3,

9, or 10.

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

the income tax year for types of use 1, 2, 3, 4, 5, or 7.

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, 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.

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.

Caution: To make an ultimate vendor claim on lines 6 and 7,

you are required to have a UV registration number (or UP

registration number, in the case of kerosene sales from a

blocked pump). If you do not have a registration number, you

cannot make a claim at this time. Use Form 637, Application

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).

for Registration (For Certain Excise Tax Activities), to apply for

one. See your income tax return instructions for information

on how to order forms.
Form 4136 (2004) Page 4

Printed on recycled paper

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.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Recordkeeping, 19 hr., 46 min.; Learning

about the law or the form, 6 min.; Preparing and sending

the form to the IRS, 20 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.

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.

Line 5. Nontaxable Use of Aviation Fuel

Claimant. The ultimate purchaser of the aviation fuel is the

only person eligible to make this claim.

Allowable uses. For lines 5b and 5c, aviation fuel taxed at a

rate of 21.9 cents a gallon, or at a reduced rate of 4.4 cents

a gallon, must have been used during the income tax year

for types of use 1, 3, 9, 10, or 11.

Line 6. 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. Write your UV

registration number on the entry line. See the Caution under

Specific Instructions on page 3.

Allowable sales. The fuel must have been sold during the

income tax year:

● For use on a farm for farming purposes or

● For 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 7. 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. Write your UV

registration number on the entry line if you are making a

claim on line 7a or 7b. For a claim on line 7c, write your UP

registration number on the entry line. See the Caution under

Specific Instructions on page 3.

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

government use by an Indian tribal government), or

● From a blocked pump.

Information to be submitted. For lines 7a and 7b, 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 8. 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 9. Gasohol Blending

Claimant. The person that produced the gasohol is the only

person eligible to make this claim.

To claim the credit on line 4 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 $.244. 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 10 of Form 4136, and

b. Line 69 of Form 1040. Also, check box b on line 69.

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

2004 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, Line 4. Nontaxable Use of Undyed Kerosene

Claimant. The ultimate purchaser of the kerosene is the only

person eligible to make this claim.

Caution: Line 4 cannot be used to make a claim for kerosene

used on a farm for farming purposes or sold from a blocked

pump. Only registered ultimate vendors may make those

claims (see line 7).

Allowable uses. For line 4, the kerosene must have been

used during the income tax year for types of use 2, 3, 7, or

8. No. 8 includes use as heating oil and use in a boat.

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 income tax year for types of use 2, 3, 6, 7,

or 8. No. 8 includes use as heating oil and use in a boat.

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

fuel used on a farm for farming purposes. Only registered

ultimate vendors may make those claims (see line 6).

TIP