Get Form 4136 2009
Tach this form to your income tax return. Attachment Sequence No. 23 Taxpayer identification number Name (as shown on your income tax return) Caution. Claimant has the name and address of the person who sold the fuel to the claimant and the dates of purchase. For claims on lines 1c and 2b (type of use 13 and 14), 3d, 4c, and 5, claimant has not waived the right to make the claim. For claims on lines 1c and 2b (type of use 13 and 14), claimant certifies that a certificate has not been provid.
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