Form 637 K Questionnaire OMB_Rev_Feb_2022

Name:		EIN:
Address:		637 Reg No.:
City, State, Zip:		OMB No.:	1545-1835

In addition to the Form 637 General Questionnaire, please answer the following questions specific to this activity. (Attach additional sheets, if needed.)

Activity Letter K: Buyer of kerosene for a feedstock purpose.

See Treas. Reg. 48.4082-7.

Registration allows buyer to purchase kerosene tax-free for use as a feedstock. 

"K" QUESTIONNAIRE

1. Does your business qualify for the Form 637 “K” Registration?

☐ Yes ☐ No

• If yes, please complete questions below and return this form.

• If no, please sign the statement below, date, and return this form.

I request my Form 637 _“K” Registration be denied or revoked as I am no longer engaged in this activity.

____________________________________ __________________

Printed Name Title

____________________________________ __________________

Signature Date

Note: This request must be signed by a person with authority to bind the applicant or registrant. Refer to Form 637, Application for Registration (For Certain Excise Tax Activities), General Instructions, under the Signature section for additional guidance.

1. List all products containing kerosene that your business manufactures.

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   Is kerosene used in any other manner beside the manufacture of these products? ☐ Yes ☐ No

If yes, describe the use.

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   List all locations and storage facilities where kerosene is stored. List the expected volume (in gallons) of kerosene to be used by each facility.

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

5. List name and address of all current and anticipated suppliers of kerosene.

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   List approximate annual quantity of kerosene purchased.

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   Does your business own fuel transports? ☐ Yes ☐ No

If yes, list Vehicle Identification Number (VIN), Gross Vehicle Weight (GVW), fuel transported and capacity of each.

VIN	GVW	Fuel Transported	Capacity

8. List the name and phone number of a person whom we can contact about this application/registration.

Form 637 K Questionnaire 2 Revised Feb 2022