OMB No. 1545-1420 Sales by Registered Ultimate Vendors

of Undyed Diesel Fuel and Undyed Kerosene

(Rev. January 2003)

Schedule 2 Department of the Treasury—Internal Revenue Service

Name as shown on Form 8849

Use on a farm for farming purposes

Use by a state or local government

(Form 8849)

Total refund (see instructions)

For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions. Cat. No. 27450U Schedule 2 (Form 8849) (Rev. 1-2003)

a

b

U V

 Attach to Form 8849. Do not file with any other schedule.

Period of claim: Enter month, day, and year

in MMDDYYYY format.

Claimant’s registration no. 

U P

Sales by Registered Ultimate Vendors of Undyed Kerosene

1

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 obtained written consent

of the buyer to make the claim; and obtained the required certificate from the buyer and has no reason to believe any

information in the certificate or statement is false.

Use on a farm for farming purposes

Use by a state or local government

a

b

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

2

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 obtained written consent

of the buyer to make the claim. For lines 2a and 2b, claimant has obtained the required certificate from the buyer and

has no reason to believe any information in the certificate is false. For line 2c, claimant has 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.

See the instructions for additional information to be submitted.

Note: UV claimant must

complete line 3 on the back.

c Sales from a blocked pump

 Complete only for line 2c.

(d)

CRN

From  To 

(d)

CRN

360

346

(a) Rate (b) Gallons (c) Amount of refund

(a) Rate (b) Gallons (c) Amount of refund

.244

.244

.244

.244

.244

Multiply col. (a) by col. (b)

Multiply col. (a) by col. (b)

$

$

EIN

$

$

$
Schedule 2 (Form 8849) (Rev. 1-2003)

Taxpayer Identification No. Name

Enter the information below for each farmer, custom harvester, or governmental unit to whom the fuel was sold. If more

space is needed, attach additional sheets. Check (K)erosene and/or (D)iesel, whichever applies, for each name listed.

3 Farmer and Government Unit Information

K D

Name as shown on Form 8849 EIN

Gallons

Page 2

Schedule 2 (Form 8849) (Rev. 1-2003)
Schedule 2 (Form 8849) (Rev. 1-2003) Page 3

Instructions

You must enter your registration number. You are registered if

you received a letter of registration with a UV (ultimate

vendor of undyed diesel fuel and undyed kerosene) or a UP

(ultimate vendor of kerosene sold from a blocked pump)

registration number from the IRS that has not been revoked

or suspended. If you do not have a registration number, you

cannot make this claim. Use Form 637, Application for

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

one.

The certificate must contain all the information as shown in

the Model Certificate in Regulations section 48.6427-9(e)(2).

Attach Schedule 2 to Form 8849. On the envelope write

“Diesel Fuel/Kerosene Claim” and mail to the IRS at the

address under Where To File in the Form 8849 instructions.

Line 1. Sales By 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 diesel fuel must have been sold during

the period of claim 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).

Claim requirements. The following requirements must be

met:

1. The claim must be for diesel fuel sold during a period

that is at least 1 week.

Note: If requirements 1–3 above are not met, see Annual

Claims in the Form 8849 instructions.

Information to be submitted. Complete Line 3, Farmer and

Government Unit Information, for each farmer, custom

harvester, or governmental unit to whom the diesel fuel was

sold and the number of gallons sold to each. If more space

is needed, attach additional sheets.

Lines 2a and 2b. Sales by Registered Ultimate

Vendors of Undyed Kerosene (Not From a Blocked

Pump)

Claimant. The registered ultimate vendor of the kerosene is

the only person eligible to make this claim.

Allowable sales. The kerosene must have been sold during

the period of claim 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).

Claim requirements. The following requirements must be

met:

1. The claim must be for kerosene sold during a period

that is at least 1 week.

2. The amount of the claim must be at least $100. To meet

this minimum, amounts from lines 2(a), (b), and (c) may be

combined.

3. The claim must be filed by the last day of the first

quarter following the earliest quarter of the claimant’s income

tax year included in the claim. For example, a calendar-year

claimant’s claim for kerosene sold during September and

October must be filed by December 31.

Note: If requirements 1–3 above are not met, see Annual

Claims in the Form 8849 instructions.

Information to be submitted. Complete Line 3, Farmer and

Government Unit Information, for each farmer, custom

harvester, or governmental unit to whom the kerosene was

sold and the number of gallons sold to each.

Line 2c. Sales by Registered Ultimate Vendors of

Undyed Kerosene From a Blocked Pump

Claimant. The registered ultimate vendor of kerosene sold

from a blocked pump is the only person eligible to make this

claim.

Claim requirements. The following requirements must be

met:

1. The claim must be for kerosene sold from a blocked

pump during a period that is at least 1 week.

2. The amount of the claim must be at least $100. To meet

this minimum, amounts from lines 2(a), (b), and (c) may be

combined.

3. The claim must be filed by the last day of the first

quarter following the earliest quarter of the claimant’s income

tax year included in the claim. For example, a calendar-year

claimant’s claim for kerosene sold during September and

October must be filed by December 31.

Note: If requirements 1–3 above are not met, see Annual

Claims in the Form 8849 instructions.

2. The amount of the claim must be at least $200. To meet

this minimum, amounts from lines 1 and 2 may be combined.

3. The claim must be filed by the last day of the first

quarter following the earliest quarter of the claimant’s income

tax year included in the claim. For example, a calendar-year

claimant’s claim for diesel fuel sold during September and

October must be filed by December 31.

Add all amounts in column (c) and enter the result in the

total refund box at the top of the schedule.

A registered ultimate vendor of undyed diesel fuel or undyed

kerosene uses Schedule 2 to make a claim for refund.

Purpose of Schedule

Required Certificate

Total Refund

UV and UP Registration Numbers

How To File