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PATIENT INFORMATION SHEETPatient Name: Acct #: Last First Middle Initial Address: City/State/Zip: Home Phone: Cell Phone: Email Address: Gender:SSN: Male Female Date of Birth: Marital Status: SingleOccupation
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Form 4116 is used to claim a credit for Federal tax paid on fuels.
Taxpayers who have paid Federal tax on fuels and want to claim a credit for it.
Form 4116 must be filled out with detailed information about the Federal tax paid on fuels and calculations for the credit claimed.
The purpose of form 4116 is to claim a credit for Federal tax paid on fuels.
Information about the type and amount of Federal tax paid on fuels, as well as the calculation of the credit claimed.
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