Form 637 - Application For Registration (For Certain Excise Tax Activities) Page 2

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Form 637 (Rev. 10-2017)
Page
Section C—For Certain Fuel Applicants
If you’re applying for fuel activities K, M, S, or Y, answer each question below by checking the “Yes” or “No” box. If you answer
“Yes” to any of these questions, provide a full explanation. Attach additional sheets if needed.
Have you or any related person (see Regulations section 48.4101-1(b)(5)) been:
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Assessed any penalty under chapter 68 of the Internal Revenue Code (or similar provision of the law of any
state) for fraudulently failing to file any return or pay any tax, and the penalty hasn’t been wholly abated,
Yes
No
refunded, or credited?
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Assessed any penalty under chapter 68 of the Internal Revenue Code, and the penalty hasn't been wholly
abated, refunded, or credited? .
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Yes
No
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Convicted of a crime under chapter 75 of the Internal Revenue Code (or similar provision of the law of any
state), or of conspiracy to commit such a crime, and the conviction hasn't been wholly reversed by a court of
competent jurisdiction? .
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Yes
No
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Convicted, under the laws of the United States or any state, of a felony for which an element of the offense is
theft, fraud, or the making of false statements, and the conviction hasn't been wholly reversed by a court of
Yes
No
competent jurisdiction? .
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Assessed any tax under section 4103 (willful failure to pay the tax imposed by section 4041(a)(1) or 4081)
and the tax hasn't been wholly abated, refunded, or credited?
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Yes
No
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Yes
No
Advised that your registration has been revoked?
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Under penalties of perjury, I declare that I have examined this application, and accompanying schedules and statements, and, to the best of my knowledge
and belief, they are true, correct, and complete.
Sign
Here
Signature
Title
Date
Type or print name below your signature.
Activity Letter
Additional Information Required
A
Manufacturer of gas guzzler automobiles,
1. List all articles you manufactured. Include advertising brochures, if available.
sport fishing equipment (including fishing
2. List the organizations or businesses (for example, state or local government or school) to which
rods and fishing poles), fishing tackle
you intend to sell articles tax free.
3. List the monthly volume of tax-free articles you intend to sell. Also, list the monthly volume of
boxes, bows, quivers, broadheads,
points, arrow shafts, taxable tires,
taxed articles you intend to sell.
taxable medical devices, or vaccines.
B
Buyer of sport fishing equipment
1. List articles you intend to purchase for further manufacturing or for resale for use by the buyer for
(including fishing rods and fishing poles),
further manufacturing.
fishing tackle boxes, gas guzzler
2. List the businesses that you will sell articles to for use in further manufacturing, if applicable.
automobiles, bows, quivers, broadheads,
3. List your other types of sales of articles other than for further manufacturing.
points, taxable medical devices, or
vaccines for further manufacture or for
resale to a buyer for further manufacture.
C
Buyer of taxable tires for use on or in
1. List the type and weight of the tires you bought.
connection with the sale of another
2. List the articles you manufactured (a) on which the tires will be used, or (b) in connection with
article the buyer manufactures and sells
which the tires will be sold.
3. List the organizations or businesses with which you intend to have tax-exempt sales.
(1) for export, (2) to state and local
governments, (3) to nonprofit educational
organizations, or (4) as supplies for
vessels or aircraft.
D
Buyer with a place of business in the
1. List the articles you intend to buy for export or resale to others for export.
United States purchasing taxable medical
2. List the businesses to which you intend to sell articles for export.
devices, vaccines, gas guzzler
automobiles, taxable tires, sport fishing
equipment (including fishing rods and
fishing poles), fishing tackle boxes, bows,
quivers, broadheads, points, or arrow
shafts for export or for resale to a second
purchaser for export.
637
Form
(Rev. 10-2017)

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