TTB Form 5120.17SMTEMP "Report of Wine Premises Operations"

What Is TTB Form 5120.17SMTEMP?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on January 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest available edition released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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FOR USE 01/01/18 - 12/31/19
OMB No. 1513-0053 (11/30/2020)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REPORT OF WINE PREMISES OPERATIONS
OPERATED BY
(Name, Address, and Telephone)
PERIOD COVERED
(Year Only, or Year & Month, or Year & Quarter)
YEAR
MONTH
_______ _____
_______________
QUARTERLY:
July to September
January to March
April to June
October to December
_______________ _______________ _______________
_______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________
_______________
VERSION
EIN
REGISTRY NUMBER
(
Select Original or Amended. Select Final if this is the last report for the business
)
Original
Amended
Final Report
___
_____
_______
_______________ _______________ _______________
_______________
_______________
_______________ _______________ _______________
_________
INSTRUCTIONS
3. Explain any unusual operations in Part X.
1. The reporting period for this form must be monthly, except that proprietors who qualify under
the exception stated in 27 CFR 24.300(g)(2) may file this form on a quarterly or calendar year
4. The quantities "on hand end" will ordinarily be "book inventory" figures, that is the quantity
basis unless required to file monthly by the Alcohol and Tobacco Tax and Trade Bureau (TTB).
required to balance each summary. Use the "on hand end" from your report for the previous period
A proprietor who files monthly reports but does not expect any reportable operations in a
as the "on hand beginning" of the current report. On reports for any period when you take a
subsequent month or months may indicate in Part X that no monthly reports will be filed until a
physical inventory, report the difference as losses for bulk wine and shortages for bottled wine, or as
reportable operation occurs (§ 24.300(g)(1)).
gains, as the case may be.
2. Prepare this form in duplicate and file it by the fifteenth day after the end of the report period
5. If the quantity of wine previously reported on TTB F 5120.17 is affected by adjustments made on
( month, quarter, or year) . Keep the copy on your bonded wine premises for inspection by TTB
a tax return, TTB F 5000.24, adjust the current TTB F 5120.17 in Section A (and Section B, if
officers. Send the original to TTB at this address: Director, National Revenue Center, Alcohol and
bottled wine is involved) . Explain the entries in Part X.
Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215.
_______________
_______________ _______________ _______________
_______________
_______________
_______________ _______________ _______________
_________
PART I - SUMMARY OF WINES IN BOND (GALLONS)
ALCOHOL CONTENT BY VOLUME
ARTIFICIALLY
CARBONATED
NOT OVER 16
OVER 16 TO 21 PERCENT
OVER 21 TO 24 PERCENT
SPARKLING WINE
HARD CIDER
1/
ITEM
WINE
PERCENT
(Inclusive)
(Inclusive)
(e)
(f)
(d)
(b)
(c)
(a)
SECTION A - BULK WINES
1. ON HAND BEGINNING OF PERIOD
BF
2. PRODUCED BY FERMENTATION
2/
BP
3. PRODUCED BY SWEETENING
4. PRODUCED BY ADDITION OF WINE SPIRITS
5. PRODUCED BY BLENDING
6. PRODUCED BY AMELIORATION
7. RECEIVED IN BOND
8. BOTTLED WINE DUMPED TO BULK
9. INVENTORY GAINS
10.
11.
0.00
0.00
0.00
0.00
0.00
12.
TOTAL
0.00
BF
13. BOTTLED
3/
BP
14. REMOVED TAXPAID
15. TRANSFERS IN BOND
16. REMOVED FOR DISTILLING MATERIAL
17. REMOVED TO VINEGAR PLANT
18. USED FOR SWEETENING
19. USED FOR ADDITION OF WINE SPIRITS
20. USED FOR BLENDING
5/
21. USED FOR AMELIORATION
22. USED FOR EFFERVESCENT WINE
23. USED FOR TESTING
24.
25.
26.
27.
28.
29. LOSSES (OTHER THAN INVENTORY)
30. INVENTORY LOSSES
31. ON HAND END OF PERIOD
0.00
0.00
0.00
0.00
0.00
0.00
32.
TOTAL
SECTION B - BOTTLED WINES
1. ON HAND BEGINNING OF PERIOD
2. BOTTLED
3/
BF
BP
3. RECEIVED IN BOND
4. TAXPAID WINE RETURNED TO BOND
5.
6.
0.00
0.00
0.00
0.00
0.00
0.00
7.
TOTAL
8. REMOVED TAXPAID
9. TRANSFERRED IN BOND
10. DUMPED TO BULK
11. USED FOR TASTING
12. REMOVED FOR EXPORT
13. REMOVED FOR FAMILY USE
14. USED FOR TESTING
15.
16.
17.
18. BREAKAGE
19. INVENTORY SHORTAGE
4/
20. ON HAND END OF PERIOD
21.
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
TTB F 5120.17smtemp (01/2018)
Hard cider: (a) Contains no more than 0.64 gram of carbon dioxide per 100 milliliters of wine; (b) Is derived primarily from apples or pears, or from apple juice concentrate or pear juice concentrate and water, as described in 27
1/
CFR 24.332(a); (c) Contains no fruit product or fruit flavoring other than apple or pear, as described in 27 CFR 24.332(b) and (c); and (d) Contains at least one-half of 1 percent and less than 8.5 percent alcohol by volume.
Enter in col. (e) on line marked "BF" the quantity of sparkling wine produced by fermentation in bottles, and on line marked "BP" the quantity of sparkling wine produced by bulk process.
2/
Section A line 13 and Section B line 2 should show the same quantities. Enter in col. (e) on line marked "BF" the quantity of finished bottle fermented sparkling wine bottled, and on line marked "BP" the quantity of finished bulk process wine
3/
bottled.
4/
Fully explain in either Part X, or on a separate signed statement submitted with this report. Failure to satisfactorily explain shortages of bottled wine may result in the assessment of taxes applicable to those shortages.
5/
Only report blending if wines of different tax classes are blended together.
Page 1 of 2
Reset
Print Blank Form
Print Completed Form
FOR USE 01/01/18 - 12/31/19
OMB No. 1513-0053 (11/30/2020)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REPORT OF WINE PREMISES OPERATIONS
OPERATED BY
(Name, Address, and Telephone)
PERIOD COVERED
(Year Only, or Year & Month, or Year & Quarter)
YEAR
MONTH
_______ _____
_______________
QUARTERLY:
July to September
January to March
April to June
October to December
_______________ _______________ _______________
_______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________
_______________
VERSION
EIN
REGISTRY NUMBER
(
Select Original or Amended. Select Final if this is the last report for the business
)
Original
Amended
Final Report
___
_____
_______
_______________ _______________ _______________
_______________
_______________
_______________ _______________ _______________
_________
INSTRUCTIONS
3. Explain any unusual operations in Part X.
1. The reporting period for this form must be monthly, except that proprietors who qualify under
the exception stated in 27 CFR 24.300(g)(2) may file this form on a quarterly or calendar year
4. The quantities "on hand end" will ordinarily be "book inventory" figures, that is the quantity
basis unless required to file monthly by the Alcohol and Tobacco Tax and Trade Bureau (TTB).
required to balance each summary. Use the "on hand end" from your report for the previous period
A proprietor who files monthly reports but does not expect any reportable operations in a
as the "on hand beginning" of the current report. On reports for any period when you take a
subsequent month or months may indicate in Part X that no monthly reports will be filed until a
physical inventory, report the difference as losses for bulk wine and shortages for bottled wine, or as
reportable operation occurs (§ 24.300(g)(1)).
gains, as the case may be.
2. Prepare this form in duplicate and file it by the fifteenth day after the end of the report period
5. If the quantity of wine previously reported on TTB F 5120.17 is affected by adjustments made on
( month, quarter, or year) . Keep the copy on your bonded wine premises for inspection by TTB
a tax return, TTB F 5000.24, adjust the current TTB F 5120.17 in Section A (and Section B, if
officers. Send the original to TTB at this address: Director, National Revenue Center, Alcohol and
bottled wine is involved) . Explain the entries in Part X.
Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215.
_______________
_______________ _______________ _______________
_______________
_______________
_______________ _______________ _______________
_________
PART I - SUMMARY OF WINES IN BOND (GALLONS)
ALCOHOL CONTENT BY VOLUME
ARTIFICIALLY
CARBONATED
NOT OVER 16
OVER 16 TO 21 PERCENT
OVER 21 TO 24 PERCENT
SPARKLING WINE
HARD CIDER
1/
ITEM
WINE
PERCENT
(Inclusive)
(Inclusive)
(e)
(f)
(d)
(b)
(c)
(a)
SECTION A - BULK WINES
1. ON HAND BEGINNING OF PERIOD
BF
2. PRODUCED BY FERMENTATION
2/
BP
3. PRODUCED BY SWEETENING
4. PRODUCED BY ADDITION OF WINE SPIRITS
5. PRODUCED BY BLENDING
6. PRODUCED BY AMELIORATION
7. RECEIVED IN BOND
8. BOTTLED WINE DUMPED TO BULK
9. INVENTORY GAINS
10.
11.
0.00
0.00
0.00
0.00
0.00
12.
TOTAL
0.00
BF
13. BOTTLED
3/
BP
14. REMOVED TAXPAID
15. TRANSFERS IN BOND
16. REMOVED FOR DISTILLING MATERIAL
17. REMOVED TO VINEGAR PLANT
18. USED FOR SWEETENING
19. USED FOR ADDITION OF WINE SPIRITS
20. USED FOR BLENDING
5/
21. USED FOR AMELIORATION
22. USED FOR EFFERVESCENT WINE
23. USED FOR TESTING
24.
25.
26.
27.
28.
29. LOSSES (OTHER THAN INVENTORY)
30. INVENTORY LOSSES
31. ON HAND END OF PERIOD
0.00
0.00
0.00
0.00
0.00
0.00
32.
TOTAL
SECTION B - BOTTLED WINES
1. ON HAND BEGINNING OF PERIOD
2. BOTTLED
3/
BF
BP
3. RECEIVED IN BOND
4. TAXPAID WINE RETURNED TO BOND
5.
6.
0.00
0.00
0.00
0.00
0.00
0.00
7.
TOTAL
8. REMOVED TAXPAID
9. TRANSFERRED IN BOND
10. DUMPED TO BULK
11. USED FOR TASTING
12. REMOVED FOR EXPORT
13. REMOVED FOR FAMILY USE
14. USED FOR TESTING
15.
16.
17.
18. BREAKAGE
19. INVENTORY SHORTAGE
4/
20. ON HAND END OF PERIOD
21.
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
TTB F 5120.17smtemp (01/2018)
Hard cider: (a) Contains no more than 0.64 gram of carbon dioxide per 100 milliliters of wine; (b) Is derived primarily from apples or pears, or from apple juice concentrate or pear juice concentrate and water, as described in 27
1/
CFR 24.332(a); (c) Contains no fruit product or fruit flavoring other than apple or pear, as described in 27 CFR 24.332(b) and (c); and (d) Contains at least one-half of 1 percent and less than 8.5 percent alcohol by volume.
Enter in col. (e) on line marked "BF" the quantity of sparkling wine produced by fermentation in bottles, and on line marked "BP" the quantity of sparkling wine produced by bulk process.
2/
Section A line 13 and Section B line 2 should show the same quantities. Enter in col. (e) on line marked "BF" the quantity of finished bottle fermented sparkling wine bottled, and on line marked "BP" the quantity of finished bulk process wine
3/
bottled.
4/
Fully explain in either Part X, or on a separate signed statement submitted with this report. Failure to satisfactorily explain shortages of bottled wine may result in the assessment of taxes applicable to those shortages.
5/
Only report blending if wines of different tax classes are blended together.
Page 1 of 2
FOR USE 01/01/18 - 12/31/19
PART II - (RESERVED)
PART III - SUMMARY OF DISTILLED SPIRITS (Pr oof Gallons)
WINE SPIRITS
SPIRITS FOR
DISTILLATES CONTAINING
USE IN NON
ALDEHYDES
6/
FOR ADDITION TO WINE
FOR PREPARATION
BEVERAGE
6/
ITEM
WINES
OF DOSAGES OR
GRAPE
ESSENCES
(a)
(h)
(e)
(f)
(g)
(b)
(c)
(d)
1. ON HAND BEGINNING OF PERIOD
0.00
2. RECEIVED
3. INVENTORY GAIN
4.
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5. USED
6. TRANS. TO COL. (e)
7.
8. LOSSES
9. ON HAND END OF PERIOD
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10.
TOTAL
PART IV - SUMMARY OF MATERIALS RECEIVED AND USED
GRAPE MATERIAL
SUGAR
KINDS OF MATERIALS OTHER THAN GRAPE
6/
(Pounds or Gallons)
GRAPES
LIQUID
DRY
ITEM
UNCRUSHED
CONCENTRATE
FIELD CRUSHED
JUICE
(Pounds)
(Gallons)
(Pounds)
(Gallons)
(Gallons)
(Gallons)
(h)
(i)
(e)
(a)
(f)
(g)
(b)
(c)
(d)
1. ON HAND BEGINNING OF PERIOD
2. RECEIVED
3. JUICE OR CONCENTRATE PRODUCED
4.
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5. USED IN WINE PRODUCTION
6.
USED IN JUICE OR CONCENTRATE PRODUCTION
7. USED IN ALLIED PRODUCTS
8. REMOVED
9. ON HAND END OF PERIOD
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10.
TOTAL
PART V - (RESERVED)
PART VI - SUMMARY OF DISTILLING MATERIAL AND VINEGAR STOCK (Gallons)
6/
DISTILLING MATERIAL
7/
VINEGAR STOCK
ITEM
(a)
(b)
(c)
(d)
1. ON HAND BEGINNING OF PERIOD (Storage Tanks)
2. PRODUCED
3. RECEIVED FROM OTHER BONDED WINE PREMISES
4.
5.
TOTAL
0.00
0.00
0.00
0.00
6. REMOVED TO DISTILLED SPIRITS PLANTS
7. REMOVED TO OTHER BONDED WINE PREMISES
8. REMOVED TO VINEGAR PLANTS
9.
10. ON HAND END OF PERIOD (Storage Tanks)
0.00
0.00
0.00
0.00
11.
TOTAL
PART VII - IN FERMENTERS END OF PERIOD (Gallons)
6/
ITEM
(a)
(b)
(c)
(d)
(e)
TOTAL
0.00
1. IN FERMENTERS (ESTIMATED QUANTITY OF LIQUID)
PART VIII - SUMMARY OF NONBEVERAGE WINES (Gallons)
OVER 16 TO 21 PERCENT ALCOHOL
TOTAL
NOT OVER 16 PERCENT ALCOHOL
(Inclusive)
(c)
ITEM
(a)
(b)
0.00
1. PRODUCED
2. WITHDRAWN
0.00
PART IX - SPECIAL NATURAL WINES AND 27 CFR 24.218 WINES (Gallons)
OTHER SPECIAL NATURAL WINES
TOTAL
27 CFR
NOT OVER 16
OVER 16 TO 21
ARTIFICIALLY
VERMOUTH
ITEMS
(cols. a, b, c, d and e)
SPARKLING
24.218 WINES
PERCENT ALCOHOL
PERCENT ALCOHOL
CARBONATED
(a)
(f)
(e)
(g)
(b)
(c)
(d)
0.00
1. PRODUCED
2. TAXABLE REMOVALS
0.00
3. ON HAND END OF PERIOD
0.00
PART X - REMARKS
Under penalties of perjury, I declare that I have examined this report, including the documents submitted in support thereof, and to the best of my knowledge and belief, it is true, correct, and complete.
PROPRIETOR
BY (Signature and Title)
DATE
State kind - apple, blackberry, etc.
6/
Distilling material includes lees, filter wash, and other residues used for production of wine spirits. See 27 CFR 24.306.
7/
PAPERWORK REDUCTION ACT NOTICE
This information collection request is in accordance with the P aperwork Reduction Act of 1995. The purpose of this information collection is for the protection of Federal Excise taxes. The information will be
used to determine compliance by payment on untaxpaid commodities. The information required is mandator y by statute (26 U.S.C. 5367).
The estimated average burden associated with this collection of information is 1 hour and 6 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade
Bureau, 1310 G Street, NW, Box 12, Washington, D.C. 20005
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number.
Page 2 of 2
TTB F 5120.17smtemp (01/2018)
Page of 2