0526 Form 8849 (Schedule 5) (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8849s5.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Schedule 5 (Form 8849)

(Rev. May 2026) Department of the Treasury Internal Revenue Service

Attach to Form 8849. Do not file with any other schedule. Go to www.irs.gov/Form8849 for instructions and the latest information.

OMB No. 1545-1420

Name as shown on Form 8849 EIN Total claim (see instructions)

$ Claimant’s registration number

Part I Claim for Refund or Payment of Tax. Caution: Section 4081(e) claims are made on Schedule 5 by the person that has filed Form 720 reporting and paying the tax claimed. Section 6435 claims are made on Schedule 5 by the person that has paid a section 4081 tax on diesel fuel or kerosene and removed from an approved terminal the diesel fuel or kerosene, which was dyed under section 4082(a).

(a) Type of fuel Amount of claim

(b) 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 (for section 4081(e) claims) 303 7 Kerosene for use in aviation 369 8 Kerosene for use in commercial aviation (other than foreign trade) 355 9 Dyed diesel fuel (for section 6435 claims) 472 10 Dyed kerosene (for section 6435 claims) 473

Type of claim Caution: Check only one per Schedule. See instructions for more information on making both section 4081(e) and 6435 claims.

Section 4081(e) claims (complete Part II) Section 6435 claims (complete Part III) Part II Supporting Information Required for Section 4081(e) Claims. 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 Enter line number from

(d) Date second tax liability incurred

Use MMDDYYYY format.

(e) Gallons of fuel claimed

(f) 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. 5-2026) Created 5/6/26

Schedule 5 (Form 8849) (Rev. 5-2026) Page 2 Part III Supporting Information Required for Section 6435 Claims. See instructions. If more space is needed, attach separate sheets.

Claimant has attached a copy of the Section 6435 Taxpayer’s Report.

(g) Type of fuel Enter line number from

(h) Date of removal of dyed fuel

Use MMDDYYYY format.

(i) Gallons of fuel claimed

(j) Amount of prior tax paid

Schedule 5 (Form 8849) (Rev. 5-2026)