Form 637 Questionnaires

Name:	EIN:
Address:	Registration No:
City, State, Zip

"UA" QUESTIONNAIRE (Revision 02-01-2006)

Ultimate vendor that sells kerosene for use in avaition.

Review Form 637, "Application for Registration" for any updates or changes. This includes Part I, II, and III. Attach the updates or changes to questionnaire. Notate if no updates or changes have been made since last visitation.

1. Who is responsible for the preparation and filing of Form 8849 or Form 4136? From what address are they filed? _______________________________________________________________________________________________________________________________________________________________________________________________________________

2. Does the company, related company, or any of its owners incur any liability for excise tax? If so, name the type of tax. __________________________________________________________________________________________________________________________________________

3. Does the company sell or plan to sell any kerosene to a related company? If so, describe the arrangements.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Has the company's excise, employment, or income tax returns been examined by the State or IRS during the previous five years? If so, what were the results of the examination?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. List the name and address of all the company's suppliers of kerosene.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Does the company store any kerosene to which it does not hold title? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained?

_______________________________________________________________________________________________________________________________________________________________________________________________________________

5. List all locations and storage facilities where kerosene is stored. List the expected volume (in gallons) of kerosene sold. Attach additional sheets if needed. (CEP and major oil companies may be exempted from this question.)

Name of Facility	Address of Facility	Capacity of Kerosene Fuel Tank(s)	Expected Annual Volume

Indicate with an (*) any facility where dyed kerosene fuel is sold.

8. Are all pumps dispensing dyed diesel fuel or kerosene labeled with a legible and conspicuous notice stating "DYED DIESEL FUEL, NONTAXABLE USE ONLY, PENALTY FOR TAXABLE USE “ or DYED KEROSENE, NONTAXABLE USE ONLY, PENALTY FOR TAXABLE USE “?

____________________________________________________________________

8. Are you or your customers reimbursed for the federal excise tax on kerosene for any credit card sales? If so, explain.

_______________________________________________________________________________________________________________________________________________________________________________________________________________

8. What are your procedures for securing exemption certificates / letters of registration from customers who purchase without the federal excise tax?

______________________________________________________________________________________________________________________________________________________________________________________________________________

8. Furnish the following information for each aircraft: Attach additional sheets if necessary.(if required)

Make & Type	Tail Number	Takeoff Weight	Own/ Operate	Avg Hrs Per Month	Commercial Aviation Avg Hrs/Month

8. If you do not own the aircraft or provide the pilot for any flight(s) of the above aircraft, explain the operating arrangements.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Does the company provide air transportation of persons, property, or both?

_________________________________________________________________________________________________________________________________________________________________________________________________________

8. Does the company provide international air transportation of persons, property, or both?

_________________________________________________________________________________________________________________________________________________________________________________________________________

8. Describe any fueling agreements with other carriers.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Does the company claim credits or refunds for aviation fuel? Explain

______________________________________________________________________________________________________________________________________

17.Please list all noncommercial airlines with taxpayer identification numbers that you

provide kerosene to. ___________________________________________________

_____________________________________________________________________

_____________________________________________________________________

TIN - DATE -