Schedule 5
(Form 8849)                        Section 4081(e) Claims
(Rev. January 2006)            Attach to Form 8849. Do not file with any other schedule.            OMB No. 1545-1420
Department of the Treasury
Internal Revenue Service
Name as shown on Form 8849                                           EIN                        Total refund (see instructions)
                                                                                                $

Claimant’s registration number
Part I  Claim for Refund of Second Tax.  Caution. Claims are made on Schedule 5 by the person that has
        filed Form 720 reporting and paying the tax claimed.
Type of fuel                                                                                    (a)                      (b)
                                                                                                Amount of refund         CRN
1 Gasoline                                                                          $                                    362
2 Aviation gasoline                                                                                                      324
3 Diesel fuel                                                                                                            360
4 Kerosene                                                                                                               346
5 Diesel-water fuel emulsion                                                                                             309
6 Dyed diesel fuel, dyed kerosene, and other exempt removals                                                             303
7 Kerosene for use in aviation                                                                                           369
8 Kerosene for use in commercial aviation (other than foreign trade)                                                     355
Part II Supporting Information Required. See instructions. If more space is needed, attach separate sheets.
        Claimant certifies that the amount of the second tax has not been included in the price of the fuel, and has not been
        collected from the purchaser. Claimant has attached a copy of the First Taxpayer’s Report, and if applicable, a copy
        of the Statement of Subsequent Seller.

  (c) Type of fuel             (d)                                   (e)                            (f) 
Enter line number from    Date second tax liability incurred
       Part I.             Use MMDDYYYY format.             Gallons of fuel claimed             Amount of second tax paid

                                                                                         $

For Privacy Act and Paperwork Reduction Act Notice, see Form 8849 instructions. Cat. No. 27453B Schedule 5 (Form 8849) (Rev. 1-2006)

Schedule 5 (Form 8849) (Rev. 1-2006)                                                                                    Page   2

Instructions                                                       Claim Requirement
Section references are to the Internal Revenue Code.               Generally, the claim must be filed within 3 years from the
                                                                   time the return for the second tax was filed or 2 years from
What’s New                                                         the time the second tax was paid to the government,
                                                                   whichever is later.
● Line 5 is used for section 4081(e) claims for a diesel-water
fuel emulsion, effective after December 31, 2005.                  Total Refund
● Line 6 is used for section 4081(e) claims for dyed diesel
                                                                   Add all amounts in column (a) and enter the result in the
fuel, dyed kerosene, and other exempt removals, effective          total refund box at the top of the Schedule.
after September 30, 2005. See Line 6 below for the fuels
applicable on line 6.                                              Part I
● Claims relating to kerosene for use in aviation are completely
revised, effective after September 30, 2005. Aviation-grade        For each type of fuel, enter the total of all amounts from
                                                                   column (f), Part II.
kerosene has been deleted from line 5. Lines 7 and 8 have been
added for kerosene for use in aviation. For section 4081(e) claims Line 6. Section 4081(e) claims can be made on line 6 for the
related to aviation-grade kerosene before October 1, 2005, use     tax on the following fuels: dyed diesel fuel, dyed kerosene,
the February 2005 revision of Schedule 5 (Form 8849).              and other exempt removals (gasoline blendstocks, kerosene
                                                                   used for a feedstock, and diesel fuel or kerosene used in
Purpose of Schedule                                                Alaska). The person that has reported a section 4081 tax on
                                                                   Form 720 and paid that tax to the government, if a prior
A person who has paid and reported a section 4081 tax to
                                                                   section 4081 tax on the fuel has also been paid and reported
the government on taxable fuel uses Schedule 5 to claim a
                                                                   to the government, makes the claim.
refund of that tax if a prior section 4081 tax on that fuel has
                                                                   Line 7. 
also been paid and reported to the government.                           Section 4081(e) claims can be made for kerosene for
                                                                   use in aviation by a person that has reported a section 4081
                                                                   tax on Form 720 (IRS No. 69) and paid that tax to the
Section 4081(e) Claims
                                                                   government if a prior section 4081 tax on the kerosene has
Section 4081(e) applies to the fuels listed in Part I.             also been paid and reported to the government.
  If two taxes were paid on the fuel for which the claim is        Line 8. Section 4081(e) claims can be made for kerosene for
filed, then a claim for refund of the second tax may be made.      use in commercial aviation (other than foreign trade) by a
Example. Janet is a taxable fuel registrant that owns 10,000       person that has reported a section 4081 tax on Form 720
gallons of gasoline that is being transported on a vessel in       (IRS No. 77) and paid that tax to the government if a prior
the United States. On June 1, 2006, Janet sells the gasoline       section 4081 tax on the kerosene has also been paid and
to Hazel, a person that is not a taxable fuel registrant. Janet    reported to the government.
is liable for tax on this sale. Janet prepares a First Taxpayer’s
Report related to this sale and gives a copy of the report to      Part II
Hazel.
  On June 4, 2006, Hazel sells the same gallons of gasoline        For each payment of a second tax, complete all the
to Caroline, a taxable fuel registrant. Hazel also gives           information required.
Caroline a copy of Janet’s First Taxpayer’s Report and a
Statement of Subsequent Seller. On June 9, 2006, the               Information to be Attached
gasoline is removed from a terminal at the rack. Caroline is       1. A copy of the First Taxpayer’s Report that relates to the
the position holder of the gasoline at the time of the removal     fuel covered by each claim and
and thus is liable for tax on the removal. Caroline pays this      2. If the fuel covered by the claim was bought from
tax to the government.                                             someone other than the first taxpayer, a copy of the
  After Caroline has filed a return of this second tax, Caroline   Statement of Subsequent Seller that the claimant received
files Form 8849 and Schedule 5 for a refund for the second         with respect to that fuel.
tax and includes a copy of the First Taxpayer’s Report and         The First Taxpayer’s Report and Statement of Subsequent
Statement of Subsequent Seller. In Part I of Schedule 5,           Seller must contain all the information as shown in Model
Caroline enters “1,840.00” in column 1(a). In Part II, Caroline    Certificates A and B in Appendix B of Pub. 510.
enters “1” in column (c); “06092006” in column (d);
“10,000.00” in column (e); and “1,840.00” in column (f).
                                                                   How To File
Claimant                                                           Attach Schedule 5 to Form 8849. On the envelope write
                                                                   “Section 4081(e) Claim” and mail to the IRS at the address
The person who reported on Form 720 and paid the second            under Where To File in the Form 8849 instructions.
tax to the government on the same fuel is the only person
eligible to make this claim.