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 (1997)

2 Nontaxable Use of Gasohol

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

$

Nontaxable Use of Gasoline

Rate Gallons Amount of credit

Off-highway business use $

1

CRN

301

Nontaxable Use of Undyed Diesel Fuel (Lines 3a, b, and c)

Rate Gallons Amount of credit

$

3

CRN

303

Use on a farm for farming purposes

b

a

c

Heating oil

b Off-highway business use

a

c

d

a

b

c

(99)

Other nontaxable use

Other nontaxable use (excluding use on a farm for

farming purposes)

%

%

© See the Instructions for Form 4136.

Type

of use

Type

of use

Type

of use

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

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

Lines 3a, b, and c: 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.

Claimant, a registered ultimate vendor, sold diesel fuel

for use by the buyer on a farm for farming purposes, or to

a state or local government for its exclusive use. Claimant

obtained the required certificate from the buyer and has

no reason to believe any of the information in the

certificate is false.

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel (Line 3d)

Caution: You cannot claim any amounts on Form 4136 that you claimed on Form 8849, Form 843, or Schedule C (Form 720).

%

97

Special motor fuels (other than LPG, LNG, or fuels used in

intercity or local buses) $

4

Compressed natural gas (credit rate per thousand cubic

feet)

Rate Gallons Amount of credit CRN

304

Nontaxable Use of Special Fuels

a

c Special motor fuels used in intercity or local buses

d

%

MCF

Type

of use

For Paperwork Reduction Act Notice, see the instructions.

b Liquefied petroleum gas (LPG) or liquefied natural gas (LNG)
Add lines 1 through 8. 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 25g; or the proper

line of other returns © $

Form 4136 (1997) Page 2

9

9

Gasohol Blenders

CRN

Percentage of alcohol in the gasohol

Rate Gallons of gasoline Amount of credit

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

7

302

Use of Undyed Diesel Fuel—Train and Intercity and Local Bus

CRN

Diesel-powered trains

8

Rate Gallons

Intercity and local buses

305

Amount of credit

b

a

c

a

b

5

6

Nontaxable Use of Aviation Gasoline

Nontaxable Use of Aviation Fuel (other than gasoline)

Other nontaxable use

Other nontaxable use

Used in commercial aviation (other than foreign trade)

$

Rate Gallons Amount of credit CRN

Rate Gallons Amount of credit CRN

307

310 a

b

a

b

%

%

% $

Type

of use

Type

of use

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

If any of the diesel fuel 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 diesel fuel to the claimant and the date(s) of the purchase(s).

Used in commercial aviation (other than foreign trade)

% $

$

Claimant bought gasoline taxed at the full rate ($.183/.184) 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.

Total Income Tax Credit Claimed
Form 4136 (1997) Page 3

Reporting Fuel Tax Credit in Income

Purpose of Form

Specific Instructions

Additional Information

Type of Use Table

The following table lists the nontaxable uses for which

you may claim a credit for taxes paid on fuels. You

must enter the item number from the table in the

applicable boxes in the Type of use column.

Recordkeeping

Changes To Note

Use Form 4136 to claim the credit for Federal excise

tax paid on fuels.

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 must include in your gross income the amount of

the credit from line 9 if you took a deduction on your

tax return for the taxes paid and that deduction

reduced your tax liability.

● Form 8849, Claim for Refund of Excise Taxes, may

be used to claim a periodic refund of excise taxes

instead of waiting to claim a credit on Form 4136.

Instructions for Form 4136

Rate Table for Fuel Tax Credits

The credit rates for Form 4136 are shown in the table

below.

Enter the applicable rate(s) as shown in the following

table in the Rate column on the form.

● Pub. 378, Fuel Tax Credits and Refunds, includes

definitions and additional excise tax rules.

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

information on credits for Federal tax paid on fuels.

Partnerships. 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 of the credits

to each partner specifying the number of gallons of

fuel allocated to each partner and the applicable tax

rates.

1. The credit for diesel-powered highway vehicles

does not apply after 1996.

2. The credit rates have been deleted from Form

4136; instead, they are shown in the Rate Table for

Fuel Tax Credits on this page. Enter the applicable

rate(s) from the table in the Rate column on the form.

3. The credit rates for aviation gasoline and aviation

fuel (other than gasoline) increased after March 6,

1997.

4. Generally, the credit rates for fuels increased by

$.001 due to reinstatement of the Leaking

Underground Storage Tank (LUST) tax after September

30, 1997.

5. The credit rate for nontaxable use of liquefied

petroleum gas and liquefied natural gas (line 4b)

decreased after September 30, 1997. See Table 2.

Item No. Type of Use

1 On a farm for farming purposes

2 For business other than in a highway vehicle registered

(or required to be registered) for highway use

3 Export

4 In a boat used in commercial fishing

5 (Reserved)

6 In an intercity or local bus

7 For diesel fuel and special motor fuels in a qualified local

bus that

● can seat at least 20 adults (excluding 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

8 In a bus that transports students and school employees

9 For diesel fuel other than as a fuel in the propulsion

engine of a diesel-powered highway vehicle or train

10 In foreign trade

11 In commercial aviation

12 In certain aircraft

Table 1

For aviation fuel used other than as a fuel in a propulsion

engine of an aircraft

For special fuels used other than as a fuel in a

propulsion engine of a motor vehicle or a motorboat

13

14

Line

No.

Rates1

Table 2

1/1/97–3/6/97

.183

.129

.14142

.15222

.243

.183

.109

.4854

—

.043

—

.043

.03967

.02979

.02158

.1875

.169

MCF

1a–c

2a

b

c

3a–d

4a

b

c

5a

b

6a

b

7a

b

c

8a

b

1

Rates are in cents per gallon, except as noted.

3/7/97–9/30/97

.193

.218

.175

.15

.183

.129

.14142

.15222

.243

.183

.109

.4854

.03967

.02979

.02158

.1875

.169

MCF

.183 .183

d

After 9/30/97

.194

.219

.175

.15

.184

.13

.14242

.15322

.244

.184

.109/.0622

/.0453

.4854

.03956

.0297

.02152

.1875

.17

MCF

.136/.1193

2

Rate for LPG.

3

Rate for LNG.
Form 4136 (1997) 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. 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:

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.

Recordkeeping 17 hr., 12 min.

Preparing and sending

the form to the IRS 23 min.

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

tax return information are confidential, as required by

Code section 6103.

Learning about the

law or the form 6 min.

Line 1

1a. Off-highway business use. You must have used

the gasoline for a business use other than in a highway

vehicle registered (or required to be registered) for

highway use. You cannot claim a credit for personal

use of gasoline.

1b. Use on a farm for farming purposes. You must

have used the gasoline on a farm for farming

purposes. You cannot claim a credit for personal use

of gasoline.

3a. Heating oil. You must have used the undyed diesel

fuel as heating oil.

3b. Off-highway business use of undyed diesel fuel.

You must have used the diesel fuel for a business use

other than in a highway vehicle registered (or required

to be registered) for highway use.

Line 3

Line 2

You must have used the gasohol for uses 1, 2, 3, 4, 6,

or 8 from Table 1. List the item number on line 2. The

credit rate per gallon is based on the percentage of

alcohol in the mixture.

1c. Other nontaxable use. You must have used the

gasoline for uses 3, 4, 6, or 8 from Table 1. List the

item number on line 1c. To claim a credit for aviation

gasoline, use line 5.

3d. Sales by registered ultimate vendors. You must

attach the following information:

2. The name and TIN of each farmer, custom

harvester, or governmental unit who bought diesel fuel

from you and the number of gallons that you sold to

each, and

1. Your UV registration number issued to you by the

IRS.

3. A statement that you have:

● Not included the amount of tax in the sales price

and not collected the amount of tax from the buyer; or

● Repaid the amount of the tax to the ultimate

purchaser of the fuel; or 

● Obtained the written consent from your buyer to

take the credit.

3c. Other nontaxable use. You must have used the

undyed diesel fuel for uses 3, 7, 8, or 9 from Table 1.

List the item number on line 3c. To claim a credit for

diesel fuel used in intercity or local buses or

diesel-powered trains, use line 8.

Caution: You cannot claim a credit on line 3c for the

tax paid on diesel fuel that you used on a farm for

farming purposes.

4a and b. Special fuels. If you bought taxed special

motor fuels, you must have used the special motor

fuels for uses 1, 2, 3, 4, 7, 8, or 14 from Table 1. List

the item number on lines 4a and b.

Line 7

Line 5

Line 6

5b. Other nontaxable uses. You must have used the

aviation gasoline for uses 1, 3, 10, or 12 from Table 1.

List the item number on line 5b.

4d. Compressed natural gas. If you bought

compressed natural gas at a price that included the

tax, you must have used the compressed natural gas

for uses 1, 2, 3, 4, 8, or 14 from Table 1. List the item

number on line 4d. The rate shown in the table is per

thousand cubic feet (MCF).

Line 8

You must have used the undyed diesel fuel for train or

intercity or local bus use. For bus uses that qualify for

a full refund of the tax, use line 3c.

Line 4

6b. Other nontaxable uses. You must have used the

aviation fuel for uses 1, 10, 12, or 13 from Table 1. List

the item number on line 6b.

If you bought gasoline taxed at the full rate, have not

claimed a refund, and used that gasoline to make

gasohol, you may take 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.