rom OG7 Application for Registration OMB No. 1545-0014
(Rev, February 1990) (For Certain Excise Tax Transactions) Expires 10-31-92

Department of the Treasury For Paperwork Reduction Act Notice, see the separate instructions. Send Both Copies to IRS.
‘qe | Name of individual, corporation, partnership, association, etc. Employer identification number
€
5 Business name, if different from above Telephone number
a (a)
Bl Business address (including number and street)
&
8
2 | City, state, and ZIP code
a
a_ Will you be required to file Form 720, b Have you previously applied for a Certificate of Registry
Quarterly Federal Excise Tax Return? . .C] Yes CINo | _orhada Certificate of Registry revoked? . . . . . .C1Yes CINo

Application is hereby made for a Certificate of Registry in the name(s) indicated above.
1 Enter your business activity, such as manufacturing, importing, wholesaling, etc.
2 Enter the products you sell and/or buy _

l affirm that this certificate will be used as specified in applicable provisions of law and regulations, and | understand that misuse of this
certificate will lead to its revocation and/or the penalties provided by law.

Under penalties of perjury, | declare that | have examined this application, and, to the best of my knowledge and belief, it is true, correct, and complete,

Signature > Title > Date >

(Please type or print name below your signature.)

District Director's Validation. —A Certificate of Registry for the above applicant is approved and issued under the number shown. Registration No.

District Director of Internal Revenue




rom O37 Application for Registration OMB No. 1545-0014
(For Certain Excise Tax Transactions) Expires 10-31-92
Send Both Copies to IRS.

(Rev. February 1990)

Pepartment of the Treasury For Paperwork Reduction Act Notice, see the separate instructions.

Name of individual, corporation, partnership, association, etc.

Employer Identification number

Telephone number
¢ )

Business name, if different from above

Business address (including number and street)

City, state, and ZIP code

Please type or print

a Will you be required to file Form 720, b Have you previously applied for a Certificate of Registry

Quarterly Federal Excise Tax Return?. .C] Yes CINo or had a Certificate of Registry revoked? . . . . . .C)Yes LINo
Application is hereby made for a Certificate of Registry in the name(s) indicated above.
1 Enter your business activity, such as manufacturing, importing, wholesaling, etc.

2 Enter the products you sell and/or buy
3 Enter a letter for each category for which you are applying. (See Registration Categories on page 1 of the separate instructions.)

\ affirm that this certificate will be used as specified in applicable provisions of law and regulations, and | understand that misuse of this
certificate will lead to its revocation and/or the penalties provided by law.
Under penalties of perjury, | declare that | have examined this application, and, to the best of my knowledge and belief, itis true, correct, and complete.

Signature > Title > Date >

(Please type or print name below your signature.)

Registration No.

District Director's Validation. —A Certificate of Registry for the above applicant is approved and issued under the number shown.

District Director of Internal Revenue