Free 2008 Form 4136 - Federal

Form

4136

Credit for Federal Tax Paid on Fuels
See the separate instructions. Attach this form to your income tax return.
Taxpayer identification number

OMB No. 1545-0162

2008
Attachment Sequence No.

Department of the Treasury Internal Revenue Service (99)

23

Name (as shown on your income tax return)

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. 1 a b c d Nontaxable Use of Gasoline
(a) Type of use Off-highway business use Use on a farm for farming purposes Other nontaxable use (see Caution above line 1) Exported (b) Rate $ .183 .183 .183 .184 411 (c) Gallons (d) Amount of credit (e) CRN $ 362

2 a b c d

Nontaxable Use of Aviation Gasoline
(a) Type of use Use in commercial aviation (other than foreign trade) Other nontaxable use (see Caution above line 1) Exported LUST tax on aviation fuels used in foreign trade *This rate applies after March 31, 2009. $ (b) Rate .15/.000* .193/.043* .194/.044* .001 (c) Gallons (d) Amount of credit (e) CRN $ 354 324 412 433

3

Nontaxable Use of Undyed Diesel Fuel

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 an explanation and check here (a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN a Nontaxable use .243 $ $ 360 b Use on a farm for farming purposes .243 c Use in trains 353 .243

d Use in certain intercity and local buses (see Caution
above line 1) .17 .244 350 413

e Exported

4

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 (a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN a Nontaxable use taxed at $.244 .243 $ $ 346 b Use on a farm for farming purposes .243

c Use in certain intercity and local buses (see Caution
above line 1)

d Exported e Nontaxable use taxed at $.044 f Nontaxable use taxed at $.219
For Paperwork Reduction Act Notice, see the separate instructions.

.17 .244 .043 .218
Cat. No. 12625R Form

347 414 377 369

4136

(2008)

Form 4136 (2008)

Page

2

5

Kerosene Used in Aviation (see Caution above line 1)
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN

a Kerosene used in commercial aviation (other than foreign
trade) taxed at $.244 $ .200 .175/.000* .243 .218/.043* .001 $ 417 355 346 369 433

b Kerosene used in commercial aviation (other than foreign
trade) taxed at $.219/.044*

c Nontaxable use (other than use by state or local
government) taxed at $.244

d Nontaxable use (other than use by state or local
government) taxed at $.219/.044*

e LUST tax on aviation fuels used in foreign trade
*This rate applies after March 31, 2009.

6

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

Registration No.

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. Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here (b) Rate (c) Gallons (d) Amount of credit (e) CRN $ 360 350

a Use by a state or local government b Use in certain intercity and local buses

$ .243 .17

7

Sales by Registered Ultimate Vendors of Undyed Kerosene (Other Than Kerosene For Use in Aviation)

Registration No.

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. Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here (b) Rate (c) Gallons (d) Amount of credit (e) CRN a Use by a state or local government $ .243 346 b Sales from a blocked pump $ .243

c Use in certain intercity and local buses

.17

347

8

Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

Registration No.

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. (a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN a Use in commercial aviation (other than foreign trade) taxed at $.219/.044* 355 $.175/.000* $

b Use in commercial aviation (other than foreign trade)
taxed at $.244 .200 .025/.200* .243 .218/.043* .001
Form

417 418 346 369 433

c d e f

Nonexempt use in noncommercial aviation Other nontaxable uses taxed at $.244 Other nontaxable uses taxed at $.219/.044* LUST tax on aviation fuels used in foreign trade *This rate applies after March 31, 2009.

4136

(2008)

Form 4136 (2008)

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9

Alcohol Fuel Mixture Credit

Registration No.

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. (b) Rate (c) Gallons of alcohol (d) Amount of credit (e) CRN $ 393 394

a Alcohol fuel mixtures containing ethanol b Alcohol fuel mixtures containing alcohol (other than ethanol)
*This rate applies after December 31, 2008.

$ .51/.45* .60

10

Biodiesel or Renewable Diesel Mixture Credit

Registration No.

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. (c) Gallons of (d) Amount of credit (e) CRN (b) Rate biodiesel or renewable diesel a Biodiesel (other than agri-biodiesel) mixtures 388 $ $.50/1.00* 390 1.00 b Agri-biodiesel mixtures

c Renewable diesel mixtures
*This rate applies after December 31, 2008.

1.00

307

11

Nontaxable Use of Alternative Fuel
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. (c) Gallons (a) Type of use (b) Rate (d) Amount of credit (e) CRN or gasoline gallon equivalents (GGE) $ Liquefied petroleum gas (LPG) $ .183 419 .183 420 "P Series" fuels .183 Compressed natural gas (CNG) (GGE = 126.67 cu. ft.) 421 Liquefied hydrogen .183 422 the Fischer-Tropsch process .243 .243 .243 .183 423 424 425 435

a b c d e Any liquid fuel derived from coal (including peat) through f Liquid fuel derived from biomass g Liquefied natural gas (LNG) h Liquefied gas derived from biomass

12

Alternative Fuel Credit and Alternative Fuel Mixture Credit
(b) Rate

Registration No.
(c) Gallons or gasoline gallon equivalents (GGE) (d) Amount of credit (e) CRN

a b c d e f g h i

Liquefied petroleum gas (LPG) "P Series" fuels Compressed natural gas (CNG) (GGE = 121 cu. ft.) Liquefied hydrogen Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process Liquid fuel derived from biomass Liquefied natural gas (LNG) Liquefied gas derived from biomass Compressed gas derived from biomass (GGE = 121 cu. ft.)

$ .50 .50 .50 .50 .50 .50 .50 .50 .50

$

426 427 428 429 430 431 432 436 437
Form

4136

(2008)

Form 4136 (2008)

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13

Registered Credit Card Issuers
(b) Rate $ .243 .243

Registration No.
(c) Gallons (d) Amount of credit (e) CRN $ 360 346 369

a Diesel fuel sold for the exclusive use of a state or local government b Kerosene sold for the exclusive use of a state or local government c Kerosene for use in aviation sold for the exclusive use of a state or local
government taxed at $.219/.044* *This rate applies after March 31, 2009.

.218/.043*

14

Nontaxable Use of a Diesel-Water Fuel Emulsion
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. (a) Type of use (b) Rate $ .197 .198 (c) Gallons

a Nontaxable use b Exported

(d) Amount of credit (e) CRN $ 309 306

15

Diesel-Water Fuel Emulsion Blending
(b) Rate Blender credit $ .046

Registration No.
(c) Gallons (d) Amount of credit (e) CRN $ 310

16

Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate (c) Gallons (d) Amount of credit (e) CRN $ 415 416

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

$ .001 .001

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.

17 $
Form

4136

(2008)