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 (2008)

2 Nontaxable Use of Aviation Gasoline

Nontaxable Use of Gasoline

(b) Rate (c) Gallons (d) Amount of credit

Off-highway business use

1

(e) CRN

362

3 Nontaxable Use of Undyed Diesel Fuel

Use on a farm for farming purposes

a

b

c Other nontaxable use (see Caution above line 1)

© See the separate instructions.

(a) Type of use

For Paperwork Reduction Act Notice, see the separate instructions.

Use in commercial aviation (other than foreign trade) 354

Other nontaxable use (see Caution above line 1)

a

b

Nontaxable use

Use in certain intercity and local buses (see Caution

above line 1)

a

b

d

Use in trains

360

350

$

4

$

$

% $ .183

.183

.183

.15/.000*

.193/.043*

.243

.243

.17

324

Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)

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 an explanation and check here ©

Nontaxable use taxed at $.244 .243 $

Caution. Claimant has the name and address of the person who sold the fuel to the claimant and the dates of

purchase. For claims on lines 1c and 2b (type of use 13 and 14), 3d, 4c, and 5, claimant has not waived the

right to make the claim. For claims on lines 1c and 2b (type of use 13 and 14), claimant certifies that a

certificate has not been provided to the credit card issuer.

c

(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN

(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN

(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN

a

c Use in certain intercity and local buses (see Caution

above line 1) .17 347

Use on a farm for farming purposes

Use on a farm for farming purposes

e .244 413

b .243

346

d Exported .184 411

c Exported .194/.044* 412

Exported

.243

d Exported .244 414

353

%

%

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

*This rate applies after March 31, 2009.

e Nontaxable use taxed at $.044 .043 377

f Nontaxable use taxed at $.219 .218 369

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

$

$

$

(99)

2008

d LUST tax on aviation fuels used in foreign trade .001 433
Form 4136 (2008) Page 2

Sales by Registered Ultimate Vendors of Undyed Kerosene (Other

Than Kerosene For Use in Aviation)

7

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here ©

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

of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.

a

b Sales from a blocked pump

c

Registration No. ©

Form 4136 (2008)

8 Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

Use in commercial aviation (other than foreign trade)

taxed at $.244

a

b

Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer,

repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. See the instructions for

additional information to be submitted.

Registration No. ©

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

346

$

.243

.243

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

355

(a) Type of use

.175/.000* $

.200

346

c Nonexempt use in noncommercial aviation .025/.200*

d Other nontaxable uses taxed at $.244 .243

Use in certain intercity and local buses .17 347

Use by a state or local government

e Other nontaxable uses taxed at $.219/.044* .218/.043*

Use in commercial aviation (other than foreign trade)

taxed at $.219/.044*

417

418

369

%

6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

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

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

consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Registration No. ©

a Use by a state or local government 360

b

$ .243 $

Use in certain intercity and local buses .17

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

350

5

*This rate applies after March 31, 2009.

Kerosene Used in Aviation (see Caution above line 1)

Kerosene used in commercial aviation (other than foreign

trade) taxed at $.244

Kerosene used in commercial aviation (other than foreign

trade) taxed at $.219/.044*

a

b

$ .200

.175/.000*

417

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

$

355

Nontaxable use (other than use by state or local

government) taxed at $.244

c

Nontaxable use (other than use by state or local

government) taxed at $.219/.044*

d

*This rate applies after March 31, 2009.

.243

.218/.043*

346

369

(a) Type

of use

$

$

e LUST tax on aviation fuels used in foreign trade .001 433

f LUST tax on aviation fuels used in foreign trade .001 433
Liquefied petroleum gas (LPG)

Form 4136 (2008) Page 3

Nontaxable Use of Alternative Fuel

“P Series” fuels

a

b

c Compressed natural gas (CNG) (GGE = 126.67 cu. ft.)

11

(b) Rate (d) Amount of credit (e) CRN

$ .183 $ 419

.183

.183

12 Alternative Fuel Credit and Alternative Fuel Mixture Credit

Liquefied petroleum gas (LPG)

“P Series” fuels

a

b

426

427

Registration No. ©

(b) Rate (c) Gallons

or gasoline 

gallon

equivalents (GGE)

(d) Amount of credit (e) CRN

$ .50

.50

$

Compressed natural gas (CNG) (GGE = 121 cu. ft.)

Liquefied hydrogen

c

d

Any liquid fuel derived from coal (including peat) through the

Fischer-Tropsch process

Liquid fuel derived from biomass

e

f

g Liquefied natural gas (LNG)

.50

.50

.50

.50

.50

428

429

430

431

432

Liquefied hydrogen

Any liquid fuel derived from coal (including peat) through

the Fischer-Tropsch process

d

e

f Liquid fuel derived from biomass

g Liquefied natural gas (LNG)

.183

.243

.243

.243

420

421

422

423

424

425

(c) Gallons

or gasoline 

gallon

equivalents (GGE)

Biodiesel (other than agri-biodiesel) mixtures 388

Agri-biodiesel mixtures

a

b 390

(b) Rate (c) Gallons of 

biodiesel or 

renewable

diesel

(d) Amount of credit (e) CRN

$.50/1.00*

1.00

$

c Renewable diesel mixtures 1.00 307

9 Alcohol Fuel Mixture Credit

Alcohol fuel mixtures containing ethanol

Alcohol fuel mixtures containing alcohol (other than ethanol)

a

b

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any

person for use as a fuel or was used as a fuel by the claimant.

Registration No. ©

(c) Gallons of

alcohol

(d) Amount of credit (e) CRN

$ .51/.45*

.60

$ 393

394

10 Biodiesel or Renewable Diesel Mixture Credit

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met

ASTM D6751 and met EPA’s registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for

use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of

Biodiesel Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing renewable diesel with diesel fuel (other than

renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass (as defined in section

45K(c)(3)) using a thermal depolymerization process, met EPA’s registration requirements for fuels and fuel additives, and met ASTM D975

or D396. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has

attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller, both of which have been edited as discussed

in the Instructions for Form 4136. See the instructions for line 10 for details.

Registration No. ©

Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 5 in the Instructions for Form 4136 for the credit rate.

(a) Type of use

(b) Rate

*This rate applies after December 31, 2008.

*This rate applies after December 31, 2008.

h Liquefied gas derived from biomass .183 435

h Liquefied gas derived from biomass

i Compressed gas derived from biomass (GGE = 121 cu. ft.)

.50

.50

436

437
Form 4136 (2008) Page 4

Form 4136 (2008)

13 Registered Credit Card Issuers

Diesel fuel sold for the exclusive use of a state or local government

Kerosene sold for the exclusive use of a state or local government

a

b

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

$ .243 360

Registration No. ©

$

17 $

17 Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on

Form 1040, line 68 (also check box b on line 68); Form 1120, line 32f(2); Form 1120S, line 

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

Kerosene for use in aviation sold for the exclusive use of a state or local

government taxed at $.219/.044*

c

346

369

.243

.218/.043*

Nontaxable use

Nontaxable Use of a Diesel-Water Fuel Emulsion

Exported

a

b

14

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

309

(a) Type of use

$ .197 $

.198 306

Blender credit

15 Diesel-Water Fuel Emulsion Blending

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

$ .046 $ 310

Registration No. ©

Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5). See page 6 in the Instructions for Form 4136 for the credit rate.

*This rate applies after March 31, 2009.

16 Exported Dyed Fuels and Exported Gasoline Blendstocks

Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001

Exported dyed kerosene

a

b

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

$ .001

.001

$ 415

416