Form 637 Questionnaires

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

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

Ultimate vendor that sells kerosene from a blocked pump.

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.

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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. List name and addresses of all suppliers of kerosene.

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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?

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

Name of Facility	Address of Facility	Capacity of K-1 Tank(s)	Expected Annual Sales

Indicate with an (*) any facility where the kerosene pump is not physically blocked.

5. If applicable, what procedures are in place for your employees when selling kerosene from a pump that is not physically blocked?

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5. Are all kerosene pumps dispensing undyed kerosene on which credit is being claimed labeled with a legible and conspicuous notice stating “UNDYED UNTAXED KEROSENE, NONTAXABLE USE ONLY”?

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5. How often is inventory of kerosene taken? Who checks inventory and how? What records are maintained?

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11. What records are used to prepare claims for undyed kerosene sold without the federal excise tax?

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