TTB Form 5230.4 "Application for Permit to Import Tobacco Products or Processed Tobacco"

What Is TTB Form 5230.4?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on February 1, 2010 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2010;
  • 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.

Download a fillable version of TTB Form 5230.4 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau.

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OMB No. 1513-0078 (02/28/2013)
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
Number
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR PERMIT TO IMPORT TOBACCO PRODUCTS OR
PROCESSED TOBACCO
Date
1. I am applying for a TTB permit to conduct business as an (See instruction C and D):
Importer of Tobacco Products
Importer of Processed Tobacco
2. I am applying because (Select one option):
I am starting a new business as stated in Item 1
I am applying for renewal of my permit
(enter permit number)
I am taking ownership of an existing business as of
(enter date)
The name and TTB permit number of this business is:
There has been a change in control of my business as of
(enter date)
The name and TTB permit number of this business is:
3. My legal name is (Read instruction H)
4. My employer identification number is(Read instruction I):
5. My trade name is or names are (Read instruction J):
6.
I have attached my trade name(s) certificate(s) (Read instruction K)
OR
I have NOT attached these certificates for the following reason:
7. My premises (physical) address is (Read Instruction L):
8. My business mailing address is: (Read Instruction L)
Same as premises address
9.
I have attached my business documents (Read Instruction M): OR
I have NOT attached
my business documents for the following reason:
TTB F 5230.4 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 1 of 3
OMB No. 1513-0078 (02/28/2013)
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
Number
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR PERMIT TO IMPORT TOBACCO PRODUCTS OR
PROCESSED TOBACCO
Date
1. I am applying for a TTB permit to conduct business as an (See instruction C and D):
Importer of Tobacco Products
Importer of Processed Tobacco
2. I am applying because (Select one option):
I am starting a new business as stated in Item 1
I am applying for renewal of my permit
(enter permit number)
I am taking ownership of an existing business as of
(enter date)
The name and TTB permit number of this business is:
There has been a change in control of my business as of
(enter date)
The name and TTB permit number of this business is:
3. My legal name is (Read instruction H)
4. My employer identification number is(Read instruction I):
5. My trade name is or names are (Read instruction J):
6.
I have attached my trade name(s) certificate(s) (Read instruction K)
OR
I have NOT attached these certificates for the following reason:
7. My premises (physical) address is (Read Instruction L):
8. My business mailing address is: (Read Instruction L)
Same as premises address
9.
I have attached my business documents (Read Instruction M): OR
I have NOT attached
my business documents for the following reason:
TTB F 5230.4 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 1 of 3
10. Persons involved with or who have financial interest in the applicant business: (Complete this section for each owner,
officer, director, partner, member, investor, shareholder or person of primary interest in the business – Read instructions N & O)
(Copy this page as many times as needed and submit all pages with your application.)
I have provided information below about each person (Read instructions N and O) on this form or as an attachment OR
I have NOT attached this information for the following reason:
a. Full legal name (No initials)
b. Other names used (alias, married name, maiden name, etc.)
c. Date of birth (individual) or organization (business entity)
e. Taxpayer identification number
f. Gender ( if
individual)
Social security number (SSN) or
Male
Employer identification number (EIN)
d. Place of birth/organization (city, State, foreign country)
Female
g. The above named person or business entity is (Select only one)
h. Is the above named person a US Citizen or
if a business entity, is it organized in the US?
Individual
Partnership
Yes
No, Country of citizenship or
Limited liability company
Corporation
organization:
Other (Specify):
i.
Residence(s), or principal places(s) of business, over the last five years (Include both if individual operated any business at a
location other than residence. Attach additional sheet of paper if more space is needed)
Period (dates) at this address
Address(es) (Street Number, Name, City, State, Country)
j.
Relationship(s) With Applicant’s Business
k. Ownership or financial interest:
(Title(s) and position(s))
(If a person or business entity holds more than 10%)
Percentage of interest:
Describe this interest (number of shares, partner, member, etc.)
l.
Name(s) and address(es) of the investment source(s)
m. Dollar amount of investment in my business
Current
Anticipated
$
$
n. Reason for, or source of, investment. (Example: savings,
loan, profits from other business, or gift)
TTB F 5230.4 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
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11.
I have completed item 10 for the person(s) having actual or legal control over my business (Read instructions O)
OR
I have identified the person(s) having actual or legal control over my business (Read instructions O) by attaching to this
application the information as required by item 10 WITH a statement on how actual or legal control is exercised
.
12. Have you or any person listed in Items 10 or 11 been denied a permit, license, or other authorization to engage in any business by
any government agency (Federal, State, local, or foreign) or had such permit, license, or other authorization revoked, suspended,
or otherwise terminated?
Yes, and I have attached to this application the details of each occurrence.
No
13. Have you or any person listed in Items 10 or 11 been arrested for, charged with, or convicted of, any crime under Federal, State, or
foreign laws? (You do not have to include arrests, charges, or convictions for operating a motor vehicle that are not felonies under
Federal or State law.)
Yes, and I have attached to this application the details of each occurrence.
No
14. Have you or any person listed in Items 10 or 11 been subject to or are currently subject to legal proceedings involving a felony
violation of any provision of Federal criminal law relating to tobacco products, processed tobacco, cigarette paper, or cigarette
tubes?
Yes, and I have attached to this application the details of each occurrence.
No
15. Have you or any person listed in Items 10 or 11 been convicted of a felony violation of any provision of Federal criminal law relating
to tobacco products, processed tobacco, cigarette paper, or cigarette tubes?
Yes, and I have attached to this application the details of each occurrence.
No
16. I declare that I have read the instructions for this form. I understand that I may need to submit additional documentation before TTB
may act on this application.
I understand that this application includes the information that I have attached to this form or incorporated by reference.
I understand that an appropriate TTB officer may require additional information to determine if I am entitled to the permit for which I
am applying.
I understand that if any information provided on this application changes before I have received a final determination from TTB on
this application, I must immediately notify, in writing, the Director, TTB National Revenue Center..
Under penalties of perjury, I have examined this application and, to the best of my knowledge and belief, this application, including
any attachments, is true, correct, and complete.
a. Signature (Read Instruction P)
b. Title
c. Date
d. E-mail Address
e. Business Telephone Number
(Area Code and phone number)
(
)
How do I file this form?
Send this form to the Director, TTB National Revenue Center, 550 Main St, Ste 8002,Cincinnati, OH 45202-5215
TTB F 5230.4 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
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DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR IMPORTER OF TOBACCO PRODUCTS
OR PROCESSED TOBACCO PERMIT
GENERAL INSTRUCTIONS
A. Why do I need this form? If you intend to operate a business to import tobacco products or processed tobacco, you must
apply for a permit under Chapter 52 of Title 26 of the Internal Revenue Code of 1986 by completing this form and filing it with
TTB. Applying for this permit does not authorize you to operate contrary to any Federal, State, or local laws. You will also
use this form to apply to renew an existing importer permit, to report a pending transfer in the ownership of the business and
to report a change in control of the business.
B. How do I file this form? Send the completed form and all required attachments to the Director, TTB National Revenue
Center, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215. We recommend that you keep a copy of all documents you
send.
C. What are tobacco products? Tobacco products are cigars, cigarettes, smokeless tobacco (snuff and chewing tobacco),
pipe tobacco, and roll-your-own tobacco. Each of these tobacco products is further defined in the Internal Revenue Code of
1986 at 26 U.S.C. 5702.
D. What is processed tobacco? Processed tobacco is any tobacco that has undergone processing, but does not include
tobacco products. The processing of tobacco does not include the farming or growing of tobacco or the handling of tobacco
solely for sale, shipment, or delivery to a manufacturer of tobacco products or processed tobacco (26 U.S.C. 5702(p)).
E. Can I obtain a permit to import tobacco products AND processed tobacco? A person that intends to engage in the
business of importing both tobacco products and processed tobacco may use this form. A person that holds a current permit to
import tobacco products must use TTB Form 5230.5 to amend that permit before engaging in the business of importing processed
tobacco.
Can I reference information that TTB already has on file? Yes, if you include:
F.
(1)
The name, address, and TTB permit number that appears on the TTB form referenced;
(2)
The TTB form and item number; and
(3)
The date that the TTB form was signed.
G. What if there is not enough space for my information? You may attach a separate sheet with any additional information.
On this form, in the space provided next to the item number, you must state that you have attached a separate sheet. On the
attachment, you must show this TTB form number (TTB F 5230.4) and the item number(s) to which the information corresponds.
INSTRUCTIONS FOR ITEMS ON THIS FORM
H. Item 3. What is my legal name?
If your business is a:
Your legal name is:
Sole Proprietorship
Your full name.
The name of each partner or the name of the partnership as filed
Partnership
with a State or local government.
Corporation, Association, Limited Liability Company, or other
The name as stated on your documents filed with the State or
business organization
local government.
Item 4. What is my employer identification number? This is the nine-digit code that the Internal Revenue Service (IRS)
I.
assigns to your business. If you do not have an employer identification number, you may obtain one by filing an IRS Form SS-4.
You may get this form from the IRS. You may also obtain an EIN by applying online at www.irs.gov
Item 5. What is a trade name? In general, a trade name is a name used to identify your business that is not its legal name. For
J.
example, your legal name may be ABC Corporation, but you use the name ABC Tobacco Products in your business operations.
Using a name in business operations includes using the name for identifying your business on invoices or letterhead.
K. Item 6. Am I required to have a trade name certificate? If your State, county, or municipal authority issues a trade name
certificate or other document authorizing the use of a trade name in connection with the transaction of business, you must submit
that certificate or document to TTB with your application. If your State, county or municipal authority does not issue such certificate
or document, you must state this fact in Item 6.
TTB F 5230.4 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Instructions: Page 1 of 4
Items 7 and 8. What if my mailing address is the same as my premises address? If your premises and mailing addresses
L.
are the same, enter your premises address in Item 7 and check the box labeled “Same as premises address” in Item 8.
NOTE: Your premises address in Item 7 must be a street address or an informal rural address. It may NOT be a post office box or
drawer. Your mailing address in Item 8 may be a street address or a post office box or drawer.
M. Item 9. What types of business documents must be attached to my application?
If your business is a:
You must attach to this application:
An accurate copy of articles OR the certificate required to be filed by any State, county, or
Partnership or association
municipality.
1. An accurate copy of the corporate charter OR certificate of corporate existence or incorporation.
This copy must be executed by the appropriate officer of the State in which incorporated.
2. An accurate copy of stockholders’ meetings, bylaws, or directors meetings that list the officers
authorized to sign documents or otherwise act on behalf of the corporation. The accuracy of
Corporation
the copy must be certified by an appropriate officer of the corporation. The authority must
include matters relating to laws and regulations issued under Chapter 52 of Title 26 of the
United States Code (Internal Revenue Code). You can use TTB F 5100.1, Signing Authority for
Corporate or LLC Officials, in place of this copy.
Limited liability company or
An accurate copy of the business document(s) filed with a State, county, or municipality when such
other business
filing is required. The copy must show that it was filed with the appropriate Government agency.
organization
For example, a limited liability company must provide an accurate copy of its operating agreement.
N. Items 10 and 11. Who must I consider as a “person”? An individual, partnership, association, company, corporation, limited
liability company, estate, or trust.
(1) Which persons must I list for item 11?
a.
Yourself, if you are the sole proprietor.
b.
Each partner, if your business is a partnership.
c.
Each officer or director, if your business is a corporation.
d.
Each position similar to an officer or director of a corporation if your business is another type of business organization.
This includes a manager, if your business is a limited liability company.
e.
A stockholder who holds more than ten percent of the stock of a corporation, limited liability company, or similar business
organization, or an investor who has or will contribute more than ten percent of the funds for the business.
(2) How do I report ownership or financial interest in the applicant business?
In Item 10, blocks ‘j’ through ‘n’, you must provide certain details concerning ownership or financial interest in the business. If
any of these blocks request information that is not pertinent to your business, you should write “not applicable” or a similar
phrase in the space provided.
A person’s ownership interest can be stated by providing the percent (%) of stock or interest held in the business. For
corporations, ownership interest can be stated as a percent – the percentage of the total number of shares or interest issued
by the business held by the individual referenced in Item 11.
Example: The company is authorized to issue 1,000 shares of stock. The company has issued only 100 shares. Shareholder
A owns 20 shares. Therefore, Shareholder A has 20% interest in the business (20 shares ÷ 100 issued shares = .20).
O. Items 10 and 11. Who exercises actual or legal control of my business? In general, a person who has the power or authority
to manage, direct, govern, or administer how your business operates.
P.
Item 16. Who may sign this application?
If your business is a:
The application must be signed by:
Sole proprietorship
You; OR An individual for whom you have filed TTB F 5000.8, Power of Attorney.
Each partner; OR The partner who has been given the authority to sign by the articles of
Partnership
partnership or similar agreement of all the partners that you have filed for this permit; OR An
individual for whom you filed TTB F 5000.8, Power of Attorney.
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Instructions: Page 2 of 4
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