4136 Form 2013

244 For Paperwork Reduction Act Notice see the separate instructions. Cat. No. 12625R Form 4136 2013 Page 2 Kerosene Used in Aviation see Caution above line 1 trade taxed at. Form Department of the Treasury Internal Revenue Service 99 OMB No* 1545-0162 Credit for Federal Tax Paid on Fuels Information about Form 4136 and its separate instructions is at www*irs*gov/form4136. Attachment Sequence No* 23 Taxpayer identification number 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. The alternative fuel mixture credit cannot be claimed on this form or on Schedule 3 Form 8849. It must be taken as a credit against your taxable fuel liability gasoline diesel fuel and kerosene reported on Form 720. Nontaxable Use of Gasoline Note. CRN is credit reference number. a Type of use a b c d Off-highway business use Use on a farm for farming purposes b Rate c Gallons Other nontaxable use see Caution above line 1 Exported d Amount of credit e CRN Use in commercial aviation other than foreign trade LUST tax on aviation fuels used in foreign trade 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 Use in trains Use in certain intercity and local buses see Caution above line 1 e a Nontaxable use taxed at. 244 government taxed at. 244 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel Registration No* of the buyer to make the claim* Claimant certifies that the diesel fuel did not contain visible evidence of dye. Use by a state or local government Than Kerosene For Use in Aviation b Sales from a blocked pump 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 at. 219 at. 244 f Nonexempt use in noncommercial aviation Page 3 Reserved alcohol 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 liquid fuel other than renewable diesel.