TAILIEUCHUNG - Biodiesel and Renewable Diesel Fuels Credit

I hereby (a) release the State of Oregon and its commissions, agencies, officers, employees, contractors, and agents, and agree to defend and indemnify the foregoing from and against any claims, demands, or costs (including attorney and expert witness fees at trial and on appeal) arising from or in any way related to claims made by applicant or any parent or subsidiary of applicant and which are related in any way to the Oregon Department of Energy’s issuance or failure to issue any pre-certification or final certification to applicant for a Business Energy Tax Credit, or the inability to obtain a. | . r 8864 Department of the Treasury Internal Revenue Service Biodiesel and Renewable Diesel Fuels Credit Attach to your tax return. OMB No. 1545-1924 _2 11 Attachment Sequence No. 141 Name s shown on return Identifying number Caution. You cannot claim any amounts on Form 8864 that you claimed or will claim on Form 720 Schedule C Form 8849 or Form 4136. Claimant has a certificate from the producer or importer of biodiesel or renewable diesel reported on lines 1 through 6 below and if applicable claimant also has a statement from the reseller. Claimant has no reason to believe that the information in the certificate or statement is false. Claimant may need to attach a copy of the certificate and statement. See Certification below. Type of Fuel a Number of Gallons Sold or Used b Rate c Column a x Column b 1 Biodiesel other than agri-biodiesel 2 Agri-biodiesel 3 Renewable diesel 4 Biodiesel other than agri-biodiesel included in a biodiesel mixture 5 Agri-biodiesel included in a biodiesel mixture 6 Renewable diesel included in a renewable diesel mixture . . 7 Qualified agri-biodiesel production 1 2 3 4 5 6 7 .10 8 Add lines 1 through 7. Include this amount in your income for 2011 see instructions 8 9 Biodiesel and renewable diesel fuels credit from partnerships S corporations cooperatives estates and trusts see instructions . . . . . . . . . . . . . . . . . . . . . 10 Add lines 8 and 9. Cooperatives estates and trusts go to line 11. Partnership and S corporations report this amount on Schedule K. All others report this amount on Form 3800 line 1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Cooperatives estates and trusts subtract line 11 from line 10. Report this amount on Form 3800 line 1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 .

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