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990

-

Exempt Organization Business Income Tax Return
T

(and proxy tax under section 6033(e))
For calendar year 2013 or other tax year beginning ____________ __ , 2013, and ending
> See separate instructions.

Department of the Treasury
Internal Revenue Semee
Check becnged
t
A [:I address
B Exempt under section
501( c )( 3 )
El 408(e)
D 403A

CI 220(e)
D 530(a)

OMB No 15450687

.20

> Information about Form 990-T and its instructions is available at www.irs.gov/form9901. Open to Public Inspection (or
> Do not enter SSN numbers on this form as it may be made public it your organization is a 501(c)(3). 501(c)(3) Organizations Only
Name of organization ( D Check box if name changed and see Instructions)
D Employer identification number
(Employees' trust, see instructions)
Briqham Younq University- Hawaii
Print
990033325
or Number, street, and room or suite no If a P 0 box, see instructions
Type BYUH Box #1955, 55-220 Kulanui Street
City or town, state or provmce, country, and ZIP or foreign postal code

D 529(a)
La'ie, HI 96762
7 gfg'ga'g'yfegfra assets F Groupexemption number (See instructions.) b
501(c) corporation
341,145,000 G Check organization type >

E "WM business am W
(see mStrucnonS)
722320

[1 501 (c) trust

5

323100

[3 Other trust

I] 401 (a) trust

H
I

Describe the organizations primary unrelated busnness activity. > Catering, print Services, Copy Center
> Yes EINo
During the tax year, was the corporation a subsidiary in an afliated group or a parent-subSIdiary controlled group? .
If Yes, enter the name and identifying number of the parent corporation > The Church of Jesus Christ or LDS 32-7300405
Telephone number P
J The books are in care of >
Unrelated Trade or Business Income
(A) income
(B) Expenses
(0) Net
1a Gross receipts or sales
395128
00
b Less returns and allowances
c Balance >
1c
395,123
00
00
153,443
2
Cost of goods sold (Schedule A, line 7) .
2
3
Gross profit. Subtract line 2 from line 1c .
. .
3
226,680
00
226,680
00
4a Capital gain net income (attach Form 8949 and Schedule D)
4a
b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)
4b
c Capital loss deduction for trusts . . . . . . . . .
4c
5
Income (loss) from partnerships and S corporations (attach statement)
5
6
Rent income (Schedule C) . . . . . . .
6
7
Unrelated debt-financed income (Schedule E) .
7
8
Interest, annUIties, royalties, and rents from controlled organizations (Schedule F)
8
9
Investment income of a section 501(c)(7), (9), or (17) organization (Schedule G)
9
10
Expl0ited exempt activ1ty income (Schedule I) .
1O
11
Advertismg income (Schedule J)
.
11
I 12
Other income (See Instructions; attach schedule).
12
2": 13
Total. Combine lines 3 through 12
. . . . . . . .
13
226,680
00
226.680
00
x
Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions,
_ v.
deductions must be directly connected With the unrelated business income.)
14
Compensation of officers, directors, and trustees (Schedule K)
14
:>15
Salaries and wages
15
220,056
00
$216
Repairs and maintenance
16
14319
00
17
. .
Bad debts
5.17
{3118
Interest (attach schedule)
18
Z19
Taxes and Ilcenses .
. . . . . . . . . . . .
19
5,851
00
20
. . . .
. .
Charitable contributions (See instmctions for limitation rules.) .
7220
E21
DepreCIatlon (attach Form 4562)
. . . . . . . . .
21
11,027
00
U2
Less depreCIation claimed on S
n .
22a
22b
11,021
00
23
Depletlon .
. . . . . . . .
.
23
24
Contributlons to deferred compens ion p ans
. . .
.o
24
U)
25
Employee benefit programs . . "O
V-. .
3
. .O
25
26
Excess exempt expenses (Sche
I) . . . . .
.U')
26
27
Excess readership costs (Schedule ._._
E
.
27
28
Other deductions (attach schedLIe)
. I .
28
19,552
00
29
Total deductions. Add lines 14 hrougn 25
.
.
. . . . . . . . . . . . .
29
270,815
00
30
Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13
30
(44,135 g)
31
Net operatlng loss deduction (limited to the amount on line 30)
. . . . . . . .
31
32
Unrelated busmess taxable Income before specific deduction. Subtract line 31 from line 30 . . .
32
(44,135
00)
33
SpeCIfic deduction (Generally $1 ,000, but see line 33 instructions for exceptions.) .
. . . .
33
34
Unrelated business taxable income. Subtract line 33 from Ilne 32. If line 33 is greater than line 32,
enter the smaller of zero or line 32 .
34
(44,135 E
For Paperwork Reduction Act Notice, see instructions.

Cat No 11291.1

Form 9904' (2013)
\Z

Page 2

Form 990-T (2013)
Part III
Tax Computation
Organizations Taxable as Corporations. See instructions for tax computation. Controlled group
35
members (sections 1561 and 1563) check here > [3 See instructions and:
a
b
c
36

Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
(1) Is
I
(2) la
|
|
(a) |$
Enter organization's share of: (1) Additional 5% tax (not more than $11,750)
$
(2) Additional 3% tax (not more than $100,000)
$
Income tax on the amount on line 34 .
. . . . . . . . . . . . . . . . >
Trusts Taxable at Trust Rates. See Instructions for tax computation. Income tax on
the amount on line 34 from: (:1 Tax rate schedule or [I Schedule D (Form 1041) .
>

37
38
39

Proxy tax. See instructions .
>
. . . . . . . . . .
Alternative minimum tax .
Total. Add lines 37 and 38 to line 35c or 36, whichever applies
Tax and Payments
403
40a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116)
b Other credits (see instructions) . . . . . . . . . . .
40b
40c
c General busmess credit. Attach Form 3800 (see instructions) .
d Credit for prior year minimum tax (attach Form 8801 or 8827) .
40d
e Total credits. Add lines 40a through 40d
. . . . . . . . . . . . . . . . . . .
Subtract line 40e from line 39
41
Other taxes Check If from El Form 4255 El Form 8611 El Form 8697 E] Form 8866 El Other (attach schedule)
42
. .
. . . .
Total tax. Add lines 41 and 42 .
43
443
44a Payments: A 2012 overpayment credited to 2013
44b
b 2013 estimated tax payments
44c
. . . . . . . .
.
c Tax depOSited With Form 8868 .
44d
d Foreign organizations: Tax paid or withheld at source (see instructions)
44e
. . . . . . . . . . .
e Backup withholding (see instructions)
44f
f Credit for small employer health insurance premiums (Attach Form 8941) .
E] Form 2439
9 Other credits and payments:
Form 4136
9,676.00
I] Other
Total > 9
9,676.00
45
Total payments. Add lines 44a through 449 . . . . . . . . . .
.
. .
. D D
Estimated tax penalty (see instructions). Check if Form 2220 is attached .
46
>
Tax due. If line 45 is less than the total of lines 43 and 46, enter amount owed .
47
>
Overpayment. If line 45 is larger than the total of lines 43 and 46, enter amount overpaid
48
Refunded P
Enter the amount of line 48 you want Credited to 2014 estimated tax F
49
m Statements Regarding Certain Activities and Other Information (see instructions)
1

__
35c
7
r
36

0

00

o

00

9,676

00

9,575

on

37
38
39

Hr
40a
41
42
43

_,
45
46
47
48
49

At any time during the 2013 calendar year, did the organization have an interest in or a Signature
or other authority over a financial account (bank, securities, or other) in a foreign country?
If YES, the organization may have to file Form TD F 90-221, Report of Foreign Bank and
Financial Accounts. If YES, enter the name of the foreign country here >

Yes

N

7

v/
During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? .
If YES, see instructions for other forms the organization may have to file.
Enter the amount of tax-exempt interest received or accrued duringt_he tax year > $
3
Schedule ACost of Goods Sold. Enter method of inventory valuation >
6
Inventory at end of year . . .
6
1
Inventory at beginning of year
1
Cost of goods sold. Subtract
00 7
168,448
2
. . . . . .
Purchases
2
line 6 from line 5. Enter here and
3
Cost of labor. . . . . .
3
4a Additional section 263A costs
In Pan I, he 2 - - - - - 7~
153,449
00
(31130?) SChedUIG)
4a
8
Do the rules of section 263A (with respect to Yes N0
J
property produced or achIred for resale) apply
4b
b Other costs (attach schedule)
5
Total. Add lines 1 through 4b
5
153,443
00
to the organization? . - - I
Under penalties of perlu , I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
Ma
'- uarer (other than taxpayer) is based on all information of which preparer has any knowledge
' correct, - y the IRS discuss this return
Here } _
10/20/14
> VP Administrative Services
W'lh "6 Preparer ShOW" be'ow
(see instructions)7 |:|Yes No
Tnle
Date
Signature of of icer
Paid
Print/Type preparers name
Preparer's Signature
Date
Check E] If
PTIN
2

Preparer
use only

sell-employed
Firm's name >
Firms address >

Firm's EIN >
Phone no
Form 990-T (2013)

i
Form 990T (2013)

Page 3

Schedule CRent lncomeWrom Real Property and Personal Property Leased With Real PrOperty)
(see instructions)
1. Description of property
(1)
(2)
(3)
(4)
2. Rent received or accrued
(a) From personal property (if the percentage of rent
for personal property is more than 10% but not
more than 50%)
(1)
(2)
(3)
(4)
Total

(b) From real and personal property (if the
percentage of rent for personal property exceeds
50% or if the rent is based on profit or income)

Total

(b) Total deductions.
Enter here and on page 1,
Part I, line 6, column (B) D

(c) Total income. Add totals of columns 2(a) and 2(b). Enter
here and on page 1, Part I, line 6, column (A)
Schedule EUnrelated Debt-Financed Income (see instructions)
1. Description of debt-financed property

3(3) Deductions directly connected With the income
in columns 2(a) and 2 (b) (attach schedule)

2. Gross income from or
allocable to debt-financed
pmpeny

3. Deductions directly connected With or aliocable to
debt-financed property
(b) Other deductions
(a) Straight line depreCIation
(attach schedule)
(attach schedule)

(1)
(2)
(3)
(4)
(:1er12290:
alIocable to debt-financed
property (attach schedule)

5. Affrggillacggztlziobasm
debt-financed property
(attach schedule)

6' diVIded
comm
by4 column
5

7 ' Gross income reportable
(column 2 x column 6)

8' Allocable
deducnons
of columns
total
6 x and
(column
3(a)
3a)

Enter here and on page 1,
Part I, line 7, column (A).

Enter here and on page 1,
Part I, line 7, column (B).

%
%
%
%

(1)
(2)
(3)
(4)

P
Totals
b
Total dividends-received deductions included in column 8
. . .
.
.
Schedule FInterest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)
Exempt Controlled Organizations
1. Name of controlled
2. Employer
6. Deductions directly
Identmcatlon number 3. Net unrelated income 4. Total of speCIfied 5. Part of column 4 that IS
organization
included in the controlling
connected With income
(loss) (see instructions)
payments made
in column 5
organization's gross income
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7. Taxable Income

8. Net unrelated income
(loss) (see instructions)

9. Total of speCified
payments made

10. Part of column 9 that is
included in the controlling
organization's gross income

11. Deductions directly
connected With income in
column 10

Add columns 5 and 10
Enter here and on page 1,
Part I, line 8, column (A)

Add cqumns 6 and 11
Enter here and on page 1,
Part I, line 8, column (B)

(1)
(2)
(3)
(4)

Totals
Form 990-T (2013)

Form 990-T (2013)

Page 4

Schedule Glnvestment Income of a Section 501 (c (7), (9), or (17) Organization (see instructions)
3. Deductions
1. Description of income
2. Amount of income
4' set-as'des
directly connected
(attach
schedule)
(attach schedule)

5. Total deductions
and set-asxdes (col 3
plus col 4)

(1)
(2)
(3)
(4)
Enter here and on page 1,
Pan I, line 9, column (A).

Enter here and on page 1,
Pan I, line 9, column (B)

Totals
. .
.
b
Schedule IExploited Exempt Activity Income, Other Than Advertising Income (see instructions)
4. Net income
2 Gross
3. Expenses
(loss) from
arelaed
directly
unrelated trade or 5. Gross income
6 Expenses
connected
busmess
(column from
that
'
1. Description of exploned actiwty
business income
productionWith
of
2 minus column
'8 no!actIVIty
unrelated
attributable
to
om trade or
column 5
business income
3) If a gain,
unrelated
busmess
busmess income
compute cols 5
through 7

7. Excess exempt
expenses
(column5'6 but
minus
column
not
more than
column 4)

(1)
(2)
(3)
(4)
Enter here and on
page 1, Part I,
line 10, col (A)
Totals

.

.

.

Enter here and on
page 1. Part I,
line 10, col (B)

Enter here and
on page 1,
Part II, line 26

b

Schedule JAdvertising Income (see instructions)
Part I
Income From Periodicals Reported on a Consolidated Basis
4. Advertising
gain or (loss) (col
2. Gross
1. Name of periodical
advertismg
adveilgzecgosts 2 minus col 3) If
income
9
a gain, compute
cois 5 through 7

5' $23130

6' Riggffh'p

7. Excess readership
costs (column 6
minus column 5, but
not more than
column 4)

(1)
(2)
(3)
(4)
b
Totals (carry to Part ll, line (5))
Income From Periodicals Reported on a Separate Basis (For each periodical l isted in Part II, fill in columns
2 through 7 on a lineby-Iine basis.)
4. Advertising
7 Excess readership
2. Gross
gain or (loss) (col
costs (column 6
1. Name of periodical
advertising
adveiilgzecosts 2 minus col 3) If
5' agilimn
6' Riggffh'p
minus column 5, but
income
9
a gain, compute
not more than
cois 5 through 7
column 4)
(1)
(2)
(3)
(4)
Totals from Part I
Enter here and on
page 1, Part I,
line 11, col (A)

W
on page 1,
Part II, line 27

Enter here and on
page 1, Part I.
line 11, col (B)

b
Totals, Part II (lines 15)
Schedule KCompensation of Officers, Directors, and Trustees (see instructions)

(1)
(2)
(3)
~
(4)
Total. Enter here and on page 1, Part II. line 14

%
%
%
%
b
Form 990-T (2013)

\

OMB No 1545-0162
;m4136

Credit for Federal Tax Paid on Fuels

Department of the Treasury
> Information about Form 4136 and its separate instructions is at www.irs.gov/form4136.
lntemal Revenue Servrce (99)
Taxpayer identification number
Name (as shown on your Income tax return)

213
Attachment
Sequence No 23

99-0083825
Brigham Younq University- Hawaii
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 To 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 certies that a certificate has not been provided to the
credit card issuer.
The alternative fuel mixture credit cannot be claimed on this form or on Schedule 3 (Form 8849). It must be taken as
a credit against your taxable fuel liability (gasoline, diesel fuel, and kerosene) reported on Form 720.
1

Nontaxable Use of Gasoline

Note. CRN is credit reference number.
(a) Type of use

a
b
c
d

2

Off-highway busmess use
Use on a farm for farming purposes
Other nontaxable use (see Caution above line 1)
Exported

13

(b) Rate
5 183
183
133
134

(d) Amount of credit

(c) Gallons
426
39393

]

(e) CRN
352

$

7397

00
41 1

Nontaxable Use of Aviation Gasoline
(a) Type of use
a
b
c
d

3

Use in commerce! avration (other than foreign trade)
Other nontaxable use (see Caution above line 1)
Exported
LUST tax on aVIation fuels used In foreign trade

(b) Rate

(d) Amount of credit

(c) Gallons

$ 15
193
194
001

$

(e) CRN
354
324
412
433

Nontaxable Use of Undyed Diesel Fuel
Claimant certifies that the diesel fuel did not contain wsrble evrdence of dye
[j
Exception. If any of the diesel fuel included in this claim did contain VlSlble evrdence of dye, attach an explanation and check here >
(d) Amount of credit (e) CRN
(c) Gallons
(a) Type of use (b) Rate
a
b
c
d

Nontaxable use
Use on a farm for farming purposes
Use in trains
Use in certain interCIty and local buses (see Caution
above line 1)

e

Exported

4

13

$ 243
243
243

8,768
509

]
$

2,279

00

360
353

17

350

244

41 3

Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)
Claimant certifies that the kerosene did not contain VlSlble eVIdence of dye.
E]
Exception. If any of the kerosene included in this claim did contain VISIble eVIdence of dye. attach an explanation and check here >
(d) Amount of credit (e) CRN
(c) Gallons
(a) Type of use (b) Rate
a
b
c

d
e
f

Nontaxable use taxed at $ 244
Use on a farm for farming purposes
Use In certain interCIty and local buses (see Caution
above line 1)
Exported
Nontaxable use taxed at $ 044
Nontaxable use taxed at $ 219

For Paperwork Reduction Act Notice, see the separate instructions.

$ 243
243
17
244
043
218
Cat No 12625R

]
$

346
347
414
377
369
Form 4136 (2013)

Page 2

Form 4136 (201a)
5

Kerosene Used in Aviation (see Caution above line 1)
(a) Type of use

(b) Rate

(d) Amount of credit

(c) Gallons

(e) CRN

a

Kerosene used In commercral aViation (other than foreign
trade) taxed at $244

$ 200

b

Kerosene used In commercral aViation (other than foreign
trade) taxed at $.219

175

355

c

Nontaxable use (other than use by state or local
government) taxed at $244

243

345

$

417

d

Nontaxable use (other than use by state or local
government) taxed at $ 219

213

369

e

LUST tax on avration fuels used in foreign trade

001

433

Sales by Registered Ultimate Vendors of Undyed Diesel Fuel

6

a
b

Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent
of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain vrsrble evrdence of dye
Exception. If any of the diesel fuel included in this claim did contain vrsrble evidence of dye. attach an explanation and check here >
E]
(d) Amount of credit (e) CRN
(c) Gallons
(b) Rate
Use by a state or local government
$ 243
$
360
Use in certain intercrty and local buses
17
350

Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Kerosene For Use in Aviation)

7

Registration No. >

Registration No_ >

Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent
of the buyer to make the claim. Claimant certifies that the kerosene did not contain wsrble evrdence of dye
I]
Exception. If any of the kerosene included in this claim did contain wsrble evrdence of dye, attach an explanation and check here >
(d) Amount of credit (e) CRN
(c) Gallons
(b) Rate
a
b
c

Use by a state or local government
Sales from a blocked pump
Use in certain interCity and local buses

Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation

8

$ 243
243
17

}
$

346
347

Registration No. D

Claimant sold the kerosene for use in avration at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the
amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim See the instructions for additional information
to be submitted.
(d) Amount of credit (e) CRN
(c) Gallons
(a) Type of use (b) Rate
a

Use in commercral avration (other than foreign trade) taxed
at $ 219

s 175

b

Use in commercral avration (other than foreign trade) taxed
at $ 244
Nonexempt use in noncommercral aViation
Other nontaxable uses taxed at $244
Other nontaxable uses taxed at $ 219
LUST tax on avration fuels used in foreign trade

200
025
243
218
001

c
d
e
f

$

355
417
418
346
369
433
Form 41 36 (2013)

I
Form 4136 (2013)
9

Page 3

Reserved

Registration No. b

(b) Rate
3
b
10

(c) Ga""s f
alcohol

(d) Amount of credit

(6) CRN

Reserved
Reserved
Biodiesel or Renewable Diesel Mixture Credit

Registration No. >

Biodiesel mixtures. Claimant produced a mixture by mixmg biodiesel With diesel fuel. The biodiesel used to produce the mixture met ASTM
D6751 and met EPA's registration reqwrements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a
fuel or was used as a fuel by the claimant Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel
Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixmg renewable diesel With liqUId fuel (other than renewable diesel)
The renewable diesel used to produce the renewable diesel mixture was derived from biomass process, met EPA's registration reqUIrements
for fuels and fuel additives, and met ASTM 0975, 0396, or other equwalent standard approved by the IRS The mixture was sold by the
claimant to any person for use as a fuel or was used as a fuel by the claimant Claimant has attached the Certificate for Biodiesel and, if
applicable. the Statement of Biodiesel Reseller, both of which have been edited as discussed in the Instructions for Form 4136 See the
instructions for line 10 for information about renewable diesel used in aVIation
('3) Rate

a
b
c
11

Biodiesel (other than agri-biodiesel) mixtures
Agri-biodiesel mixtures
Renewable diesel mixtures

(0) Ga'lons 0'
biodiesel or
renewable
diesel

$1 00
$1 00
$1 00

(d) Amount of credit

$

(6) CRN

388
390
307

Nontaxable Use of Alternative Fuel
Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).
(a) Type of use

a
b
c
d
e
f
g
h

Liquefied petroleum gas (LPG)
P Series" fuels
Compressed natural gas (CNG) (GGE = 126 67 cu ft)
Liquefied hydrogen
Fischer-Tropsch process liqmd fuel from coal (including
peat)
Liqwd fuel derived from biomass
Liquefied natural gas (LNG)
Liquefied gas derived from biomass

(b) Rate

$ 183
183
183
183

Liquefied petroleum gas (LPG)
P Series" fuels
Compressed natural gas (CNG) (GGE = 121 cu. ft.)
Liqueed hydrogen
Fischer-Tropsch process liqUId fuel from coal (including peat)
Liquid fuel derived from biomass
Liqueed natural gas (LNG)
Liquefied gas derived from biomass
Compressed gas derived from biomass (GGE = 121 cu ft)

(e) CRN

419
420
421
422
423
424
425
435

Registration No. >
(b) Rate

a
b
c
d
e
1'
g
h
i

$

243
243
.243
183

Alternative Fuel Credit

12

(d) Amount of credit
(c) Gallons
or gasoline
gallon
equivalents (GGE)

$ 50
50
50
50
50
50
50
50
50

(C) Gallons
(d) Amount of credit
or gasoline
gallon
equivalents (GGE)
$

(9) CR"

426
427
428
429
430
431
432
436
437
Form 41 36 (2013)

Form 4136 (2013)
13

Registered Credit Card Issuers

Page 4
Registration No. >
(b) Rate

a
b

Dlesel fuel sold for the excluswe use of a state or local government
Kerosene sold for the exclusive use of a state or local government

c

Kerosene for use In avratlon sold for the excluswe use of a state or local
government taxed at $ 219

14

$

(e) CRN
360
346

218

369

Nontaxable Use of a Diesel-Water Fuel Emulsion

a
b

15

Caution. There IS a reduced credit rate for use In certain Intercity and local buses (type of use 5) (see instructlons).
(c) Gallons I (d) Amount of credit
(a) Type of use (b) Rate
Nontaxable use
5 .197
I$
Exported
198
I

Diesel-Water Fuel Emulsion Blending

16

(e) CRN
309
306

Registration No. b
(b) Rate

Blender credit

(d) Amount of credit

(c) Gallons

5 046

$

I

(e) CRN
310

Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate
a
b

17

(d) Amount of credit

(c) Gallons

5 243
243

Exported dyed diesel fuel and exported gasollne blendstocks taxed at $001
Exported dyed kerosene

(c) Gallons

$ 001
001

Total income tax credit claimed. Add lines 1 through 16, column (d) Enter here and on Form
1040, line 70; Form 1120, Schedule J, line 19b; Form 11208, lIne 23c; Form 1041, lune 249; or
the proper line of other returns D

I (d) Amount of credit
I$
I

17 $

(e) CRN
415
416

9575
00
Form 4136 (2013)


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