Form Ia 4136 - Iowa Fuel Tax Credit For Calendar Year Filters - 2014
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1Iowa
Department of Revenue
2014 IA 4136
Iowa Fuel Tax Credit for Calendar Year Filers
Name(s)
SSN or FEIN
Tax Period Ending Date
▲
Fuel Used For:
[Please check appropriate box(es)]
1) Farming
2) Commercial
3) Commercial
4) Other
Fishing
(specify)
A
B
C
D
E
Fuel Type
Gasoline
Gasohol
E85
Undyed
Special Fuel
Diesel Fuel
(LPG)
Iowa Fuel Tax per Gallon
21¢
19¢
19¢
22.5¢
20¢
1. Number of gallons from
original invoices.
2. Gallons used on highway.
3. Gallons claimed. Subtract
▲
▲
▲
▲
▲
line 2 from line 1.
4. Fuel tax credit. Multiply line
$
$
$
$
$
3 by the fuel tax rate.
5. Sales tax. Non-exempt use.
▲
▲
▲
▲
▲
$
$
$
$
$
See instructions.
6. Net amount of tax credit.
$
$
$
$
$
Subtract line 5 from line 4.
▲
$
7. Total Fuel Tax Credit (Add line 6 over columns A through E) ..........................................................................
See following page for instructions.
Include a copy of the federal Form 4136.
*1441005019999*
41-005a (02/27/15)
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