Form 637 Questionnaires

Name	EIN:
Address	Registration No
City, State, Zip

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

Ultimate vendor that sells undyed diesel fuel or undyed kerosene for certain intercity and local buses. Definitions—(1) Intercity bus transportation—(i) In general. An automobile bus is engaged in intercity bus transportation if it is engaged in the furnishing (for compensation) of passenger land transportation available to the general public and the bus is engaged in- (A) Scheduled transportation along regular routes; or (B) Nonscheduled transportation if the seating capacity of the bus is at least 20 adults (not including the driver).

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 diesel fuel or kerosene to a related company? If so, describe the arrangements.

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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?

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5. Does your company provide an exclusive contract for the sell of undyed diesel fuel or undyed kerosene for certain intercity and local buses?

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6. Are you registered or required to be registered by state or local authorities for the petroleum business? If so, list the licensing agencies and numbers and dates granted.

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6. List all locations and storage facilities where diesel fuel is stored. List the expected volume (in gallons) of diesel fuel used at each facility. If facility does not have bulk storage, and all diesel fuel is delivered directly into the fuel supply of buses, notate Bus in the column "Capacity of Diesel Fuel Tanks". Attach additional sheets if needed. (CEP and major oil companies may be exempted from this question.)

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

Indicate with an (*) any tank that contains dyed diesel or dyed kerosene

6. Furnish the following information for all vehicles used by your company: Attach additional sheet if necessary. Indicate in the column "Type of Fuel Used":

Dyed = Dyed Diesel Fuel; Undyed = Undyed Diesel Fuel; or Dyed kerosene or Undyed Kerosene or Gasoline.

Model	Year	License Plate #	Seating Capacity	Type Fuel Used

6. Are claims or credits being filed for undyed diesel fuel or undyed kerosene used in intercity or local buses? If yes, what form is the company using to file the claim?

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6. Does the company provide diesel fuel or kerosene or public or private school buses? If yes, provide the name and address of the bus company or schools district.

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6. Does the company that you sell diesel fuel or kerosene to have a regular scheduled intercity or local bus transportation? If yes, provide the route schedules.

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6. Does the company store any diesel fuel or 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?

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6. List all locations and storage facilities where diesel fuel or kerosene is stored that will sell undyed diesel fuel or kerosene to intercity and local buses. List the expected volume (in gallons) of undyed diesel fuel or kerosene sold to these entities. Attach additional sheets if needed. (CEP and major oil companies may be exempted from this question.)

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

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

6. 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 “?

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

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6. What are your procedures for securing exemption certificates from customers who purchase without the federal excise tax?

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6. List the names and addresses of all customers that you have sold or plan to sell undyed diesel fuel and/or kerosene without the federal excise tax? Indicate with an * any customer who purchases in bulk quantities.

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6. Do you sell biodiesel?

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6. Does the company store any fuel to which it does not hold title? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained? Who is filing claims for these sales to state/local government and farmers for farming purposes?

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6. Do you sell undyed diesel fuel and/or kerosene on consignment? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained? Who is filing claims for these sales to state/local government and farmers for farming purposes?

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6. Have any of your drivers inadvertently mixed undyed diesel fuel with dyed diesel fuel (or visa versa) or kerosene? If so, what was done with the fuel and was a claim filed?

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