OMB No. 1545-1420
Section 4081(e) Claims
(Rev. January 2006)
Department of the Treasury
Internal Revenue Service
Schedule 5
Name as shown on Form 8849
Claimant certifies that the amount of the second tax has not been included in the price of the fuel, and has not been
collected from the purchaser. Claimant has attached a copy of the First Taxpayer’s Report, and if applicable, a copy
of the Statement of Subsequent Seller.
Type of fuel
Gasoline
Aviation gasoline
(a)
Amount of refund
(Form 8849)
Total refund (see instructions)
(b)
CRN
For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions. Cat. No. 27453B Schedule 5 (Form 8849) (Rev. 1-2006)
362
324
Kerosene
Attach to Form 8849. Do not file with any other schedule.
(c) Type of fuel
Enter line number from
Part I.
(d)
Date second tax liability incurred
(f)
Amount of second tax paid
(e)
Gallons of fuel claimed
Part I
Part II
Supporting Information Required. See instructions. If more space is needed, attach separate sheets.
Claim for Refund of Second Tax. Caution. Claims are made on Schedule 5 by the person that has
filed Form 720 reporting and paying the tax claimed.
Diesel fuel
1
4
3
2
360
Use MMDDYYYY format.
Claimant’s registration number
$
$
EIN
$
346
Diesel-water fuel emulsion5 309
Dyed diesel fuel, dyed kerosene, and other exempt removals
6 303
Kerosene for use in aviation
7 369
Kerosene for use in commercial aviation (other than foreign trade)
8 355
Page 2Schedule 5 (Form 8849) (Rev. 1-2006)
Instructions
Section 4081(e) Claims
Section 4081(e) applies to the fuels listed in Part I.
If two taxes were paid on the fuel for which the claim is
filed, then a claim for refund of the second tax may be made.
Claimant
Claim Requirement
Part I
Part II
Information to be Attached
1. A copy of the First Taxpayer’s Report that relates to the
fuel covered by each claim and
2. If the fuel covered by the claim was bought from
someone other than the first taxpayer, a copy of the
Statement of Subsequent Seller that the claimant received
with respect to that fuel.
How To File
Section references are to the Internal Revenue Code.
Purpose of Schedule
Example. Janet is a taxable fuel registrant that owns 10,000
gallons of gasoline that is being transported on a vessel in
the United States. On June 1, 2006, Janet sells the gasoline
to Hazel, a person that is not a taxable fuel registrant. Janet
is liable for tax on this sale. Janet prepares a First Taxpayer’s
Report related to this sale and gives a copy of the report to
Hazel.
On June 4, 2006, Hazel sells the same gallons of gasoline
to Caroline, a taxable fuel registrant. Hazel also gives
Caroline a copy of Janet’s First Taxpayer’s Report and a
Statement of Subsequent Seller. On June 9, 2006, the
gasoline is removed from a terminal at the rack. Caroline is
the position holder of the gasoline at the time of the removal
and thus is liable for tax on the removal. Caroline pays this
tax to the government.
After Caroline has filed a return of this second tax, Caroline
files Form 8849 and Schedule 5 for a refund for the second
tax and includes a copy of the First Taxpayer’s Report and
Statement of Subsequent Seller. In Part I of Schedule 5,
Caroline enters “1,840.00” in column 1(a). In Part II, Caroline
enters “1” in column (c); “06092006” in column (d);
“10,000.00” in column (e); and “1,840.00” in column (f).
The person who reported on Form 720 and paid the second
tax to the government on the same fuel is the only person
eligible to make this claim.
Generally, the claim must be filed within 3 years from the
time the return for the second tax was filed or 2 years from
the time the second tax was paid to the government,
whichever is later.
For each payment of a second tax, complete all the
information required.
Attach Schedule 5 to Form 8849. On the envelope write
“Section 4081(e) Claim” and mail to the IRS at the address
under Where To File in the Form 8849 instructions.
Total Refund
Add all amounts in column (a) and enter the result in the
total refund box at the top of the Schedule.
The First Taxpayer’s Report and Statement of Subsequent
Seller must contain all the information as shown in Model
Certificates A and B in Appendix B of Pub. 510.
What’s New
Line 5 is used for section 4081(e) claims for a diesel-water
fuel emulsion, effective after December 31, 2005.
Line 6 is used for section 4081(e) claims for dyed diesel
fuel, dyed kerosene, and other exempt removals, effective
after September 30, 2005. See Line 6 below for the fuels
applicable on line 6.
Claims relating to kerosene for use in aviation are completely
revised, effective after September 30, 2005. Aviation-grade
kerosene has been deleted from line 5. Lines 7 and 8 have been
added for kerosene for use in aviation. For section 4081(e) claims
related to aviation-grade kerosene before October 1, 2005, use
the February 2005 revision of Schedule 5 (Form 8849).
A person who has paid and reported a section 4081 tax to
the government on taxable fuel uses Schedule 5 to claim a
refund of that tax if a prior section 4081 tax on that fuel has
also been paid and reported to the government.
Line 6. Section 4081(e) claims can be made on line 6 for the
tax on the following fuels: dyed diesel fuel, dyed kerosene,
and other exempt removals (gasoline blendstocks, kerosene
used for a feedstock, and diesel fuel or kerosene used in
Alaska). The person that has reported a section 4081 tax on
Form 720 and paid that tax to the government, if a prior
section 4081 tax on the fuel has also been paid and reported
to the government, makes the claim.
Line 7. Section 4081(e) claims can be made for kerosene for
use in aviation by a person that has reported a section 4081
tax on Form 720 (IRS No. 69) and paid that tax to the
government if a prior section 4081 tax on the kerosene has
also been paid and reported to the government.
Line 8. Section 4081(e) claims can be made for kerosene for
use in commercial aviation (other than foreign trade) by a
person that has reported a section 4081 tax on Form 720
(IRS No. 77) and paid that tax to the government if a prior
section 4081 tax on the kerosene has also been paid and
reported to the government.
For each type of fuel, enter the total of all amounts from
column (f), Part II.
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