(Form 8849) (Rev. January 2003) Nontaxable Use of Fuels. Summary: This is an example of Schedule 1 (Form 8849). The following line items are completed:
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“Name as shown on Form 8849” field contains Steven S. Sands
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“Employer Identification Number or Social Security Number” field contains 109876543
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“Total refund (see instructions)” field contains $1281
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“Period of claim--Enter month, day, and year in MMDDYYYY format:”
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“From” field contains 01012003
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“To” field contains 06302003
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“3. Nontaxable Use of Undyed Diesel Fuel:”
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“3a. Nontaxable use (see Caution above)”
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“(a) Type of use” field contains 02
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“(c) Gallons” field contains 5250
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“(d) Amount of refund. Multiply column (b) by column (c)” field contains
$1,281
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