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

Form 4136 (And Credit for Purchase of Diesel-Powered Highway Vehicles)

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) Social security or employer identification number

Diesel-Powered Highway Vehicle Credit

(a)

Number of

vehicles

(c)

Credit

(col. (a) 3 col. (b))

(b)

Credit per vehicle

1 Diesel-powered cars $102.00 $

2 Diesel-powered light trucks and vans 198.00

3 Total diesel-powered highway vehicle credit. Add lines 1 and 2, column (c) © $

Fuel Tax Credit

Cat. No. 12625R Form 4136 (1994)

Part I

Part II

1

2

3 318

Caution: If you claimed any fuel tax refunds on Form 8849, Claim for Refund of Excise Taxes, Form 843, Claim for Refund and Request

for Abatement, or Schedule C (Form 720), Adjustments and Claims, you cannot claim those amounts as credits on Form 4136.

5 Nontaxable Use of Gasohol (See instructions.)

Rate Gallons Amount of credit CRN

312

Gasohol containing at least 10% alcohol

Gasohol containing at least 7.7% alcohol but less than 10% alcohol

Gasohol containing at least 5.7% alcohol but less than 7.7% alcohol

$.13

.1424

.1532

Nontaxable Use of Gasoline (See instructions.)

Rate Gallons Amount of credit

Off-highway business use $.184

4

CRN

301

Nontaxable Use of Undyed Diesel Fuel (except for use on a farm for farming purposes or for the exclusive use of a state

or local government) and Sales by Registered Ultimate Vendors of Diesel Fuel (See instructions.)

Rate Gallons Amount of credit

$.244

6

CRN

303

CRN

Use on a farm for farming purposes .184

.184

b

a

c

Heating oil

Off-highway business use

Registered ultimate vendors

b

a

c

.244

.244

d .244

a

b

c

(99)

Lines 6a, b, and c: Claimant bought undyed diesel fuel, certifies that the diesel fuel did not contain visible evidence of dye, and used that

diesel fuel for a nontaxable use.

Line 6d: Claimant sold undyed diesel fuel (a) to a state or local

government for its exclusive use or (b) for use by the buyer on a

farm for farming purposes. Claimant is a registered ultimate vendor,

sold the fuel at a tax-excluded price, certifies that the diesel fuel did

not contain visible evidence of dye, and obtained the required

certificate from the buyer, and has no reason to believe any of the

information in the certificate is false.

Other nontaxable use (specify) ©

Other nontaxable use (specify) ©

%

%

%
12 Total fuel tax credit. Add lines 4–11 © $

Total Income Tax Credit

Total income tax credit claimed (add lines 3 and 12). Enter here and on Form 1040, line

59 (also check box b on line 59); Form 1120, line 32g; Form 1120-A, line 28g; Form

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

Form 4136 (1994) Page 2

Part III

12

13

13

Gasohol Blenders (See instructions.)

Claimant bought gasoline taxed at the full rate ($.184) and blended it with alcohol to make gasohol. The gasohol was used

or sold for use in a trade or business.

Percentage of alcohol in the gasohol Rate Gallons of gasoline Amount of credit CRN

At least 10% alcohol

At least 7.7% alcohol but less than 10% alcohol

At least 5.7% alcohol but less than 7.7% alcohol

$.0396

.0298

.0216

10

302

Train and Intercity and Local Bus Use of Undyed Diesel Fuel (See instructions.)

Claimant bought undyed diesel fuel, certifies that the diesel fuel did not contain visible evidence of dye, and used the

diesel fuel in an engine that propels a diesel-powered train or an automobile bus.

CRN

Diesel-powered trains

11

Rate Gallons

Certain intercity and local buses

$.175

.17

305

Amount of credit

b

a

c

a

b

8

Special motor fuel (other than LPG)

9

Gasoline Used in Aviation

Aviation Fuel (other than gasoline)

$.184

Used in foreign trade, on a farm, or in certain helicopters

Used in commercial aviation (other than foreign trade)

Used in foreign trade, on a farm, or in certain helicopters

Used in commercial aviation (other than foreign trade)

$.219

.218

$.184

.183

7

Compressed natural gas (credit rate per thousand cubic feet) .4854

Rate Gallons Amount of credit CRN

Rate Gallons Amount of credit CRN

Rate Gallons Amount of credit CRN

304

307

310

Nontaxable Use of Other Fuels

a

b

a

b

a

b

Liquified petroleum gas (LPG)

LPG used in intercity or local buses

.183

c .109

d MCF

%

%

%

%

%
Form 4136 (1994) Page 3

Preparing and sending

the form to the IRS 10 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 both the IRS and

the Office of Management and Budget

at the addresses listed in the

instructions of the tax return with which

this form is filed.

Paperwork Reduction Act Notice.—We

ask for the information on this form to

carry out the Internal Revenue laws of

the United States. You are required to

give us the information. 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 10 hr., 12 min.

Requirements.—To claim a credit you

must (1) use the fuel for a purpose listed

in the Type of Use Table, (2) buy taxed

fuel, and (3) not have requested or

received a refund of the tax.

Including Fuel Tax Credit in Income.—

You must include the amount of the

credit from line 12, Part II, in your gross

income if you took a deduction on your

tax return for the taxes paid and that

deduction reduced your tax liability.

General Instructions

Purpose of Form.—Form 4136 is used

by individuals, estates, trusts, or

corporations to claim credit for Federal

excise tax paid on fuels and to claim the

credit for diesel-powered highway

vehicles. (Partnerships cannot file this

form; instead, they must attach a

statement to Form 1065, U.S.

Partnership Return of Income, showing

the number of gallons of fuel allocated

to each partner and the applicable tax

rates.)

Part II

Lines 1 and 2, column (a).—Enter on

line 1 the number of diesel-powered

cars you purchased this year. Enter on

line 2 the number of diesel-powered

light trucks and vans.

Specific Instructions

Part I

Diesel-Powered Highway Vehicle.—If

you bought a diesel-powered highway

vehicle during the year for a use other

than resale and you are the first

purchaser, you may claim a one-time

credit of $102 for an automobile and

$198 for a light truck or van. The vehicle

must be a diesel-powered highway

vehicle that has at least four wheels, has

a gross vehicle weight rating of 10,000

pounds or less, and is registered under

the laws of any state for highway use in

the United States. If you claim the credit

for diesel-powered vehicles, you must

reduce the depreciable basis of the

vehicle by the credit claimed.

Additional Information.—Get Form

8849, Claim for Refund of Excise Taxes,

to claim a quarterly refund of excise

taxes instead of claiming credit on Form

4136. Get Pub. 378, Fuel Tax Credits

and Refunds, for definitions and

additional excise tax rules. Pub. 225,

Farmer’s Tax Guide, and Pub. 510,

Excise Taxes for 1995, also contain

information on the credit for Federal tax

on fuels. You can get these items by

calling 1-800-TAX-FORM

(1-800-829-3676).

Type of Use Table

This table lists the uses for which you

may claim a credit for taxes paid on

fuels. You must write in the number for

the type of use on lines 4c and 6c. See

Pub. 378 for definitions of these uses.

1. Use on a farm for farming purposes.

8. Use in a bus while the bus is

transporting students or employees of

schools.

9. Use of diesel fuel other than as a

fuel in the propulsion engine of a

diesel-powered highway vehicle, train, or

boat. See line 6a to claim a credit for

heating oil.

11. Use in commercial aviation.

12. Use in certain helicopters.

Line 5, Nontaxable Use of Gasohol

You may claim a credit for the tax

included in the price of gasohol used for

uses 1, 2, 3, 4, 6, 8, and 10 from the

Type of Use Table. The credit rate per

gallon is based on the percentage of

alcohol in the mixture. Also, see line 10

to claim a credit for gasoline blended to

make gasohol.

Line 6, Nontaxable Use of Undyed

Diesel Fuel and Sales by

Registered Ultimate Vendors of

Diesel Fuel

CAUTION: A fuel credit cannot be

claimed for any use of dyed diesel fuel

and any nontaxable use of undyed diesel

fuel for which a refund was claimed.

10. Use in foreign trade.

Line 4, Nontaxable Use of

Gasoline

4a. Off-highway business use.—To

claim this credit, you must have used

the gasoline for a business use other

than in a vehicle registered (or required

to be registered) for highway use.

4b. Use on a farm for farming

purposes.— To claim this credit, you

must have used the gasoline on a farm

for farming purposes. You cannot claim

a credit for personal use of gasoline.

4c. Other nontaxable uses of

gasoline.—You may claim a credit of

18.4 cents a gallon for gasoline used for

uses 3, 4, 6, 8, and 10 from the Type of

Use Table. List the number for the type

of use on line 4c. Also, see line 8 to

claim a credit for gasoline used in

aviation.

2. Business use other than in a vehicle

registered (or required to be registered)

for highway use.

3. Export. Proof of exportation must be

attached.

5. Use of diesel fuel in a boat in (1) the

business of transporting persons or

property for compensation or hire or (2)

any other trade or business, except an

activity of a type generally considered to

be entertainment, amusement, or

recreation.

6. Use in an intercity or local bus.

7. Use of diesel fuel in a qualified local

bus, which is a local bus that has

seating capacity of at least 20 adults

(not including the driver) and is under

contract by a state or local government

to furnish (for compensation) intracity

passenger land transportation that is

available to the general public and is

scheduled and along regular routes.

Recordkeeping.—Records must be kept

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.

6a. Heating oil.—You may claim a credit

of 24.4 cents a gallon for undyed diesel

fuel that is used as heating oil.

6b. Off-highway business use of

undyed diesel fuel.—To claim this

credit, you must have used the diesel

fuel for a business use other than in a

vehicle registered (or required to be

registered) for highway use.

4. Use in a boat in the business of

commercial fishing.

All claims for nontaxable uses of

diesel fuel on lines 6a, 6b, and 6c must

include the following information:

1. The name, address, telephone

number, and Taxpayer Identification

Number (TIN) of the person(s) that sold

diesel fuel to the claimant and the dates

of purchase;

2. The seller’s statement that the

diesel fuel did not contain visible

evidence of dye; and

3. Proof of exportation if the fuel was

exported.
Form 4136 (1994) Page 4

9b. Used in commercial aviation (other

than foreign trade).—Aviation fuel

generally may be bought for use in

commercial aviation at a price that only

includes the LUST tax. However, if you

bought aviation fuel taxed at the full

rate, you may claim a credit of 21.8

cents a gallon for the tax included in the

price of aviation fuel used for

commercial aviation.

7a, b, and c. Special motor fuel.—

Special motor fuel generally may be

bought for nontaxable purposes at a

price that does not include the excise

tax. However, if you bought taxed

special motor fuel, you may claim a

credit on line 7a of 18.4 cents a gallon

for the tax included in the price of

special motor fuel used for uses 1, 2, 3,

4, 7, or 8 from the Type of Use Table.

The credit rate on line 7b is 18.3 cents a

gallon for these uses of liquefied

petroleum gas (LPG). The credit rate on

line 7c is 10.9 cents for LPG used in

intercity or local buses.

Line 10, Gasohol Blender Credit

Line 8, Gasoline Used in Aviation

Line 9, Aviation Fuel (other than

gasoline)

9a. Used in foreign trade, on a farm,

or in certain helicopters.—Aviation fuel

generally may be bought for nontaxable

purposes at a price that does not

include the excise tax. However, if you

bought taxed aviation fuel, you may

claim a credit of 21.9 cents a gallon for

the tax included in the price of aviation

fuel used for uses 1, 10, or 12 from the

Type of Use Table.

Lines 4 through 11, gallons column.—

Enter the number of gallons of fuel used

for the purposes listed in the Type of

Use Table. (Enter the number of

thousands of cubic feet of compressed

natural gas on line 7d.)

Lines 4 through 11, Amount of credit

column.—For each of lines 4 through

11, combine the credits figured on lines

a, b, c, and d, and enter the total in the

amount of credit column.

8a. Used in foreign trade, on a farm,

or in certain helicopters.—You may

claim a credit of 18.4 cents a gallon for

the tax included in the price of gasoline

used in aviation for uses 1, 10, or 12

from the Type of Use Table. If you

bought gasoline for use in aviation at a

rate other than 18.4 cents a gallon,

attach an explanation of the amount of

credit you are claiming.

8b. Used in commercial aviation.—You

may claim a credit of 18.3 cents a gallon

for the tax included in the price of

gasoline used in commercial aviation.

7d. Compressed natural gas.—

Compressed natural gas generally may

be bought for nontaxable purposes at a

price that does not include the excise

tax. However, if you bought compressed

natural gas at a price that included the

tax, you may claim a credit of 48.54

Printed on recycled paper

Each claim for credit must include the

following information for each batch of

gasohol (the batch-by-batch method):

1. The name, address, and employer

identification number of the supplier(s) of

the gasoline and alcohol,

2. The dates of purchase of the

gasoline and alcohol,

3. The total number of gallons of

gasoline and alcohol purchased, and

4. The total number of gallons and the

type of gasohol produced.

Line 11, Train and Certain Intercity

and Local Bus Use of Undyed

Diesel Fuel

To claim this credit, you must have used

the undyed diesel fuel for train or certain

intercity or local bus use and not have

claimed a refund on Form 8849, Form

843, or Form 720. You cannot claim a

credit for any use of dyed diesel fuel.

A bus operator may file a claim for the

difference between the full rate of tax

and the bus rate of tax if the bus is used

to furnish (for compensation) passenger

land transportation available to the

general public and either the seating

capacity of the bus is at least 20 adults

(not including the driver) or such

transportation is scheduled and along

regular routes. A bus is available to the

general public if the bus is available for

hire to more than a limited number of

persons, groups, or organizations. See

the Line 6 instructions for bus uses that

qualify for a full refund of the tax.

6c. Other nontaxable use of undyed

diesel fuel.—You may claim a credit of

24.4 cents a gallon for undyed diesel

fuel used for uses 3, 4, 5, 7, 8, and 9

from the Type of Use Table. List the

type of use on line 6c. Also, see line 11

to claim a credit for undyed diesel fuel

used in certain intercity or local buses or

diesel-powered trains.

CAUTION: You must be registered with

the IRS as an “ultimate vendor” or

registered as a producer of diesel fuel to

claim this credit. You cannot claim a

credit for any amounts claimed as a

refund on Form 8849 or Form 843.

Each claim for credit by a registered

ultimate vendor must include the

following information:

6d. Registered Ultimate Vendors.—

If you bought gasoline taxed at the full

rate, have not claimed a refund, and

used that gasoline to make gasohol, you

may claim a credit for each gallon of

gasoline used to make gasohol. The

credit rate per gallon is based on the

percentage of alcohol in the mixture.

Line 7, Nontaxable Use of Other

Fuels

3. The name, address, telephone

number and TIN of each farmer, custom

harvestor, or governmental unit that

bought undyed diesel fuel and the

number of gallons that the claimant sold

to each.

1. A copy of the claimant’s registration

letter or certificate of registry;

2. The name, address, telephone

number, and employer identification

number (EIN) of each person that sold

diesel fuel to the claimant and the date

of purchase; and

1. The name, address, telephone

number, and TIN of the person(s) that

sold diesel fuel to the claimant and the

dates of purchase; and

2. The seller’s statement that the

diesel fuel did not contain visible

evidence of dye.

Each claim on this line must include

the following information:

cents per thousand cubic feet (MCF) for

the tax included in the price of

compressed natural gas used for uses 1,

2, 3, 4, 7, or 8 from the Type of Use

Table.