Fillable Form 4136 Credit for Federal Tax Paid on Fuels 2019 pdf

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Form 4136 Credit for Federal Tax Paid on Fuels 2019 pdf

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Form 4136
Department of the Treasury
Internal Revenue Service (99)
Credit for Federal Tax Paid on Fuels
▶
Go to www.irs.gov/Form4136 for instructions and the latest information.
OMB No. 1545-0162
2019
Attachment
Sequence No.
23
Name (as shown on your income tax return) Taxpayer identification number
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 or 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 or 14), claimant certifies that a certificate has not been provided to the
credit card issuer.
1
Nontaxable Use of Gasoline
Note: CRN is credit reference number.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a
Off-highway business use $ .183
b
Use on a farm for farming purposes .183 362
c
Other nontaxable use (see Caution above line 1) .183 $
d
Exported .184 411
}
2
Nontaxable Use of Aviation Gasoline
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a
Use in commercial aviation (other than foreign trade) $ .15 $ 354
b
Other nontaxable use (see Caution above line 1)
.193
324
c
Exported .194 412
d
LUST tax on aviation fuels used in foreign trade .001 433
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
b
Use on a farm for farming purposes .243 $ 360
c
Use in trains .243 353
d
Use in certain intercity and local buses (see Caution
above line 1)
.17 350
e
Exported .244 413
}
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
b
Use on a farm for farming purposes
.243 $ 346
c
Use in certain intercity and local buses (see Caution
above line 1)
.17 347
d
Exported .244 414
e
Nontaxable use taxed at $.044 .043 377
f
Nontaxable use taxed at $.219 .218 369
}
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 12625R
Form 4136 (2019)
Form 4136 (2019)
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 $ 417
b
Kerosene used in commercial aviation (other than
foreign trade) taxed at $.219
.175 355
c
Nontaxable use (other than use by state or local
government) taxed at $.244
.243 346
d
Nontaxable use (other than use by state or local
government) taxed at $.219
.218 369
e
LUST tax on aviation fuels used in foreign trade .001 433
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
a
Use by a state or local government $ .243 $ 360
b
Use in certain intercity and local buses .17 350
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
b
Sales from a blocked pump .243 $ 346
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
$ .175
$ 355
b
Use in commercial aviation (other than foreign trade)
taxed at $.244
.200 417
c
Nonexempt use in noncommercial aviation .025 418
d
Other nontaxable uses taxed at $.244 .243 346
e
Other nontaxable uses taxed at $.219 .218 369
f
LUST tax on aviation fuels used in foreign trade .001 433
Form 4136 (2019)
Form 4136 (2019)
Page 3
9 Reserved for future use
Registration No.
▶
(b) Rate (c) Gallons
of alcohol
(d) Amount of credit (e) CRN
a Reserved for future use
$
b Reserved for future use
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 liquid fuel (other than renewable diesel).
The renewable diesel used to produce the renewable diesel mixture was derived from biomass, met EPA’s registration requirements for fuels
and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. 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, Statement
of Biodiesel Reseller, both of which have been edited as discussed in the instructions for line 10. See the instructions for line 10 for information
about renewable diesel used in aviation.
(b) Rate
(c) Gallons
of biodiesel or
renewable diesel
(d) Amount of credit (e) CRN
a Biodiesel (other than agri-biodiesel) mixtures
$1.00
$
388
b Agri-biodiesel mixtures
1.00 390
c Renewable diesel mixtures
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 instructions.
(a) Type of use (b) Rate
(c) Gallons,
or gasoline
or diesel gallon
equivalents
(d) Amount
of credit
(e) CRN
a
Liquefied petroleum gas (LPG) (see instructions) $ .183 $ 419
b
“P Series” fuels .183 420
c
Compressed natural gas (CNG) (see instructions) .183 421
d
Liquefied hydrogen .183 422
e
Fischer-Tropsch process liquid fuel from coal
(including peat)
.243 423
f
Liquid fuel derived from biomass .243 424
g
Liquefied natural gas (LNG) (see instructions) .243 425
h
Liquefied gas derived from biomass .183 435
12
Alternative Fuel Credit
Registration No.
▶
(b) Rate
(c) Gallons, or
gasoline or diesel
gallon equivalents
(d) Amount of credit (e) CRN
a Liquefied petroleum gas (LPG) (see instructions)
$ .50
$ 426
b
“P Series” fuels .50
427
c Compressed natural gas (CNG) (see instructions)
.50
428
d Liquefied hydrogen
.50
429
e Fischer-Tropsch process liquid fuel from coal (including peat)
.50
430
f Liquid fuel derived from biomass
.50
431
g Liquefied natural gas (LNG) (see instructions)
.50
432
h Liquefied gas derived from biomass
.50
436
i Compressed gas derived from biomass
.50
437
Form 4136 (2019)
Form 4136 (2019)
Page 4
13
Registered Credit Card Issuers
Registration No.
▶
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a
Diesel fuel sold for the exclusive use of a state or local government $ .243 $ 360
b
Kerosene sold for the exclusive use of a state or local government .243 346
c
Kerosene for use in aviation sold for the exclusive use of a state or local
government taxed at $.219
.218 369
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 instructions.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a
Nontaxable use $ .197 $ 309
b
Exported .198 306
15 Diesel-Water Fuel Emulsion Blending
Registration No.
▶
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
Blender credit $ .046 $ 310
16
Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a
Exported dyed diesel fuel and exported gasoline blendstocks taxed
at $.001
$ .001 $ 415
b
Exported dyed kerosene .001 416
17
Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on
Schedule 3 (Form 1040 or 1040-SR), line 12; Form 1120, Schedule J, line 20b; Form 1120-S,
line 23c; Form 1041, Schedule G, line 16b; or the proper line of other returns . . . .
▶
17
$
Form 4136 (2019)
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Completed 11 May 2020

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