Form 637 Questionnaires

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

"UV" QUESTIONNAIRE (Revision 02-06-2006)

Ultimate vendor that sells (a) undyed diesel fuel or undyed kerosene to a state or local government for its exclusive use or (b) gasoline (including aviation gasoline to a state or local government for its exclusive use or to a nonprofit educational for its exclusive use.

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, kerosene, or gasoline 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 the name and address of all the company's suppliers of gasoline, diesel fuel, or kerosene.

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5. Does the company store any gasoline, kerosene, or diesel 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?

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5. List all locations and storage facilities where gasoline, kerosene, and diesel fuel is stored that will sell undyed diesel fuel or gasoline to state/local governments or non-profit educational organization. List the expected volume (in gallons) of undyed gasoline /diesel/kereosene fuel 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 Tank(s)	Expected Annual Volume

Indicate with an (*) any facility where dyed diesel 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 “?

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

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

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8. 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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8. Do you sell biodiesel?

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8. 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 governments and/or nonprofit educational organizations?

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8. 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, nonprofit educational organization, and farmers for farming purposes?

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8. 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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