Transcription of Section 4081(e) Claims
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Section 4081(e) Claims
OMB No. 1545-1420 Section 4081(e) Claims (Rev. January 2006)Department of the TreasuryInternal Revenue ServiceSchedule 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 beencollected from the purchaser. Claimant has attached a copy of the First Taxpayer s Report, and if applicable, a copyof the Statement of Subsequent of fuelGasolineAviation gasoline(a)Amount of refund(Form 8849)Total refund (see instructions)(b)CRNFor Privacy Act and Paperwork Reduction Act Notice, see Form 8849 No. 27453 BSchedule 5 (Form 8849) (Rev. 1-2006)362324 Kerosene Attach to Form 8849. Do not file with any other schedule.(c) Type of fuelEnter line number fromPart I.
Schedule 5 (Form 8849) (Rev. 1-2006) Page 2 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
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