OMB No. 1545-1420 Claim for Refund of Excise Taxes

(Rev. January 2002)

Department of the Treasury—Internal Revenue Service

Name of claimant

Address (number, street, room or suite no.)

Form

8849

City and state or province. If you have a foreign address, see page 2.

Foreign country, if applicable. Do not abbreviate.

Month claimant’s income

tax year ends

ZIP code

Social security number (SSN)

Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Schedules Attached

Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

Schedule 6

Caution: Do not use Form 8849 to make adjustments to liability reported on Forms 720 for prior quarters that were or will be made

on Form 720X, Amended Quarterly Federal Excise Tax Return, or to claim any amounts that were or will be claimed on Schedule

C (Form 720), Claims, or Form 4136, Credit for Federal Tax Paid on Fuels.

Nontaxable Use of Fuels

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel and Undyed Kerosene

Gasohol Blending

Sales by Gasoline Wholesale Distributors

Section 4081(e) Claims

Other Claims

Sign

Here

Under penalties of perjury, I declare (1) that I have examined this claim, including accompanying schedules and statements, and to the best

of my knowledge and belief, it is true, correct, and complete, and (2) that amounts claimed on this form have not been, and will not be, claimed

on any other form.

Signature and title (if applicable) Date

Type or print your name below signature.

Cat. No. 20027J Form 8849 (Rev. 1-2002)

Please print in ALL CAPITAL LETTERS. Leave a blank box between words.

Daytime telephone number (optional)

Check () the appropriate box(es) for the schedule(s) you attach to Form 8849. Only attach the schedules on which you are claiming

a refund. Claims on Schedules 2, 3, 5, and section 4091(d) claims on Schedule 6 cannot be combined with any other schedules

on Form 8849. File each of these schedules with a separate Form 8849.
Form 8849 (Rev. 1-2002) Page 2

General Instructions

Section references are to the Internal Revenue Code.

Additional Information

You may find the following publications helpful when

preparing Form 8849. The publications have definitions of

terms used in the instructions.

● Pub. 510, Excise Taxes for 2002, has more information on

excise taxes.

Purpose of Form

Use Schedules 1 through 5 to claim certain fuel related

refunds such as nontaxable uses (or sales) of fuels. Form

8849 lists the schedules by number and title.

Use Schedule 6 for claims not reportable on Schedules

1–5, including refunds of excise taxes reported on:

● Form 720, Quarterly Federal Excise Tax Return, including

section 4091(d) claims;

How To Fill In Form 8849

● Use a dark ink pen.

● Print names and words in ALL CAPITAL LETTERS. Begin

printing in the first box on the left. Leave a blank box

between each name and word. If there are not enough

boxes, print as many letters as there are boxes. Use hyphens

for compound names; use one box for each hyphen.

Name and Address

Print the information in the spaces provided. See How To Fill

In Form 8849 above.

P.O. box. If your post office does not deliver mail to your

street address and you have a P.O. box, show your box

number instead of your street address.

Foreign address. Enter the information in the following

order: city, state or province, and the name of the country.

Follow the country’s practice for entering the postal code. Do

not abbreviate the country’s name.

Taxpayer Identification Number (TIN)

Enter your employer identification number (EIN) in the boxes

provided. If you are not required to have an EIN, enter your

social security number (SSN). An incorrect or missing number

will delay processing your claim.

Month Income Tax Year Ends

Enter the month your income tax year ends. For example, if

your income tax year ends in December, enter “12” in the

boxes. If your year ends in March, enter “03”.

Signature

Form 8849 must be signed by a person with authority to sign

this form for the claimant.

● Pub. 378, Fuel Tax Credits and Refunds, has more

information on nontaxable uses.

● Form 11-C, Occupational Tax and Registration Return for

Wagering; or 

● Form 2290, Heavy Highway Vehicle Use Tax Return.

● Form 730, Monthly Tax on Wagering; 

Where To File

● For Schedules 1, 4, and 6 (except section 4091(d) claims

on Schedule 6), mail Form 8849 to:

Internal Revenue Service

Cincinnati, OH 45999-0002

Filers only need to complete and attach to Form 8849 the

applicable schedules.

● Amount of refund.

Information for Completing Schedules 1–5

Note: Your refund will be delayed or Form 8849 will be

returned to you if you do not follow the required procedures

or do not provide all the required information. See the

instructions for each schedule.

Complete each schedule and attach all information

requested for each claim you make. Be sure to enter your

name and TIN on each schedule you attach. Generally, for

each claim, you must enter the:

● Period of the claim. 

● Rate (as needed). See the separate schedule instructions. 

● Number of gallons. 

● Item number (when requested) from the Type of Use Table

on page 3.

Including the Refund in Income

● For Schedules 2, 3, 5, and 6 (only section 4091(d) claims

on Schedule 6), mail Form 8849 to:

Internal Revenue Service

P.O. Box 312

Covington, KY 41012-0312

Include any refund of excise taxes in your gross income if

you claimed the amount of the tax as an expense deduction

that reduced your income tax liability. See Pub. 378 for more

information.

If you need more space for any line on a schedule (for

example, you have more than one type of use) prepare a

separate sheet with the same information. Include your name

and TIN.

Do not use Form 8849:

● To make adjustments to liability reported on Forms 720

filed for prior quarters. Use new Form 720X or

● To claim amounts that you took or will take as a credit on

Schedule C (Form 720) or Form 4136.

Caution: Private delivery services designated by the IRS

cannot deliver items to P.O. boxes. You must use the U.S.

Postal Service to mail any item to an IRS P.O. box address.

For details on designated private delivery services, see Pub.

509, Tax Calendars for 2002.
Form 8849 (Rev. 1-2002) Page 3

Additional Information for Schedules 1, 2,

and 3

Annual Claims

An annual claim must be made on Form 4136, Credit for

Federal Tax Paid on Fuels, for the income tax year during

which the fuel was:

● Used by the ultimate purchaser, 

The following claimants must use Form 8849 (Schedule 1)

for annual claims:

1. The United States,

For claimants included in 1–3 above, the annual Form

8849 for fuel used during the taxable year must be filed

within the 3 years following the close of the taxable year. For

these claimants, the taxable year is based on the calendar

year or fiscal year it regularly uses to keep its books.

Privacy Act and Paperwork Reduction Act Notice. We ask

for the information on the form and schedules to carry out

the Internal Revenue laws of the United States. We need it to

figure and collect the right amount of tax. Subtitle F,

Procedure and Administration, of the Internal Revenue Code

allows refunds of taxes imposed under Subtitle D,

Miscellaneous Excise Taxes. The form and schedules are

used to determine the amount of the refund that is due to

you. Section 6109 requires you to provide your taxpayer

identification number (SSN, ITIN, or EIN). Routine uses of tax

information include giving it to the Department of Justice for

civil and criminal litigation, and cities, states, and the District

of Columbia for use in administering their tax laws. We may

also disclose this information to Federal, state, or local

agencies that investigate or respond to acts or threats of

terrorism or participate in intelligence or counterintelligence

activities concerning terrorism.

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.

The time needed to complete and file the form and

schedules will vary depending on individual circumstances.

The estimated average times are:

If you have comments concerning the accuracy of these

time estimates or suggestions for making the form and

schedules simpler, we would be happy to hear from you. You

can write to the Tax Forms Committee, Western Area

Distribution Center, Rancho Cordova, CA 95743-0001. Do

not send Form 8849 to this address. Instead, see Where To

File on page 2.

● Used to produce gasohol.

3. Organizations exempt from income tax under section

501(a) (provided that the organization is not required to file a

Form 990-T, Exempt Organization Business Income Tax

Return, for that taxable year).

● Sold by the registered ultimate vendor, or 

2. A state, political subdivision of a state, or the District of

Columbia, and

Type of Use

1 On a farm for farming purposes

2 Off-highway business use (for business use other than

in a highway vehicle registered or required to be

registered for highway use)

3 Export

4 In a boat engaged in commercial fishing

5

6

In certain intercity and local buses

7

For diesel fuel and kerosene 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)

10

In foreign trade

11

12

Certain helicopter and fixed-wing air ambulance uses

For aviation fuel used other than as a fuel in the

propulsion engine of an aircraft

17

In a highway vehicle owned by the United States that

is not used on a highway

Exclusive use by a nonprofit educational organization

In an aircraft or vehicle owned by an aircraft museum

Exclusive use by a state, political subdivision of a

state, or the District of Columbia

16

15

14

13

For use in the production of special fuels

Enter the period of the claim for each type of claim using the

MMDDYYYY format. For example, the first quarter of 2002

for a calendar-year taxpayer would be 01012002 to

03312002.

The following table lists the nontaxable uses of fuels. You

must enter the number from the table in the Type of Use

column as required on Schedules 1 and 4.

Recordkeeping Preparing, copying,

assembling, and sending

the form to the IRS

Learning about

the law or the

form

Schedule 1

Form 8849

Schedule 2

Schedule 3

Schedule 4

Schedule 5

Schedule 6

9 hr., 48 min.

3 hr., 35 min.

7 hr., 39 min.

3 hr., 21 min.

4 hr., 46 min.

5 hr., 15 min.

4 hr., 18 min.

30 min.

12 min.

6 min.

12 min.

9 min.

34 min.

19 min.

3 min.

4 min.

11 min.

16 min.

Period of Claim

Type of Use Table

In military aircraft

Note: Gasoline used by the above claimants on a farm for

farming purposes (type of use no. 1) is an allowable use on

Line 1 of Schedule 1.

No.