Form 4136 2003 Credit for Federal Tax Paid on Fuels. Summary: This is an example of Form 4136, page 1. The following line items are completed:
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“Name (as shown on your income tax return)” field contains Steven S. Sands
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“Taxpayer identification number” field contains 514-00-3894
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“3. Nontaxable Use of Undyed Diesel Fuel”:
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“3a. Nontaxable use:”
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“(a) Type of use” field contains 2
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“(c) Gallons” field contains 3,000
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“(d) Amount of credit” field contains $732.00
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