TTB Form 5230.5 "Application for Amended Permit to Import Tobacco Products or Processed Tobacco"

What Is TTB Form 5230.5?

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 5230.5 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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Download TTB Form 5230.5 "Application for Amended Permit to Import Tobacco Products or Processed Tobacco"

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OMB No. 1513-0078 (02/28/2013)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR AMENDED PERMIT TO IMPORT TOBACCO
PRODUCTS OR PROCESSED TOBACCO
INSTRUCTIONS
This form must be filed by every importer of tobacco products or processed tobacco when required by 26 U.S.C. 5712 and the
regulations in 27 CFR Part 41. This application must be filed with the National Revenue Center, Alcohol and Tobacco Tax and Trade
Bureau.
All supporting documents required by the regulations, and any additional information the National Revenue Center may require, must
be made a part of this application. All the information called for by the items below and any separate instructions relating to this form
must be furnished.
If additional space is needed for any item, use the reverse or attach a separate sheet.
TO:
1.
DATE OF APPLICATION
DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
2.
NUMBER OF PERMIT NOW HELD
STE 8002
550 MAIN ST
CINCINNATI, OHIO 45202-5215
3.
EFFECTIVE DATE OF PERMIT NOW HELD
4.
NAME AND ADDRESS ON PERMIT NOW HELD
5.
MAILING ADDRESS (NOTE: TTB will use this address to
correspond with you.)
6.
EMPLOYER IDENTIFICATION NUMBER
7.
DAYTIME TELEPHONE NUMBER (Including area code)
(
)
THE UNDERSIGNED HEREBY MAKES APPLICATION FOR AN AMENDED PERMIT AS INDICATED BELOW
LOCATION/ADDRESS OR
MAILING ADDRESS OF MY BUSINESS TO IMPORT TOBACCO
8.
CHANGE THE
PRODUCTS OR PROCESSED TOBACCO (Number, street/route, city/town, county, State, and Zip code)
9.
CHANGE IN TRADE NAME/
NAME(S)
OPERATING NAME(S)
ADDITION
DELETION
ADDITION
DELETION
ADDITION
DELETION
TTB F 5230.5 (02/2010)
PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 1 of 2
OMB No. 1513-0078 (02/28/2013)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR AMENDED PERMIT TO IMPORT TOBACCO
PRODUCTS OR PROCESSED TOBACCO
INSTRUCTIONS
This form must be filed by every importer of tobacco products or processed tobacco when required by 26 U.S.C. 5712 and the
regulations in 27 CFR Part 41. This application must be filed with the National Revenue Center, Alcohol and Tobacco Tax and Trade
Bureau.
All supporting documents required by the regulations, and any additional information the National Revenue Center may require, must
be made a part of this application. All the information called for by the items below and any separate instructions relating to this form
must be furnished.
If additional space is needed for any item, use the reverse or attach a separate sheet.
TO:
1.
DATE OF APPLICATION
DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
2.
NUMBER OF PERMIT NOW HELD
STE 8002
550 MAIN ST
CINCINNATI, OHIO 45202-5215
3.
EFFECTIVE DATE OF PERMIT NOW HELD
4.
NAME AND ADDRESS ON PERMIT NOW HELD
5.
MAILING ADDRESS (NOTE: TTB will use this address to
correspond with you.)
6.
EMPLOYER IDENTIFICATION NUMBER
7.
DAYTIME TELEPHONE NUMBER (Including area code)
(
)
THE UNDERSIGNED HEREBY MAKES APPLICATION FOR AN AMENDED PERMIT AS INDICATED BELOW
LOCATION/ADDRESS OR
MAILING ADDRESS OF MY BUSINESS TO IMPORT TOBACCO
8.
CHANGE THE
PRODUCTS OR PROCESSED TOBACCO (Number, street/route, city/town, county, State, and Zip code)
9.
CHANGE IN TRADE NAME/
NAME(S)
OPERATING NAME(S)
ADDITION
DELETION
ADDITION
DELETION
ADDITION
DELETION
TTB F 5230.5 (02/2010)
PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 1 of 2
10. CHANGE IN OPERATIONS AUTHORIZED –
PLEASE AMEND MY PERMIT TO AUTHORIZE IMPORTATION OF PROCESSED TOBACCO
The applicant agrees, by accepting the amended permit applied for herein, that issuance thereof will not relieve him of any liability
heretofore incurred. All data, written statements, affidavits, evidence, or other documents heretofore filed and those submitted in
support hereof, or upon any hearing will be deemed to be a part of this application.
Under the penalties of perjury, I declare that all statements made in this application for amended permit, and all data, written
statements, affidavits, evidence or other documents submitted in support hereof, or upon any hearing, are true to the best of my
knowledge and belief.
11. SIGNATURE
12. TITLE OR STATUS *
13. TYPED OR PRINTED NAME
*(State whether individual owner, partner, member officer, or if officer of corporation, give title)
TTB F 5230.5 (02/2010)
PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 2 of 2
ADDITIONAL INSTRUCTIONS
a. The permit to be amended must be attached to this application.
b. If State law requires registration of trade names, proof of registration must be submitted with this application. If State
law does not require registration, a statement to that effect must be included on this application.
c. If the corporate name is changed, certified copies of amended Articles of Incorporation must be submitted with the
application.
d. Issuance of an amended permit does not extend the expiration date of the permit. A person holding a current permit
to import tobacco products or processed tobacco must submit an application to renew the permit within 30 days of
the expiration date shown on the permit.
FOOTNOTE
1. A change in legal name often occurs as a result of a transfer of ownership. If there is a transfer of ownership, then
you must file TTB F 5230.4, not this form.
2. What is the legal name?
IF THE BUSINES IS A:
THE LEGAL NAME IS:
Sole Proprietorship
Sole proprietor’s full name
The name of each partner or the name of the partnership as filed with
Partnership
a State or local government
Corporation, association, limited liability
The name as stated on the documents filed with the State or local
company, or other business organization
government
PRIVACY ACT INFORMATION
4. EFFECTS OF NOT SUPPLYING INFORMATION
REQUESTED. Failure to supply complete
The following information is provided pursuant to Section
information will delay processing and may cause
3 of the Privacy Act of 1974 (5 U.S.C. 552(e)(3)):
denial of the application.
1. AUTHORITY. Solicitation of this information is
made pursuant to 26 U.S.C. 5712. Disclosure of this
PAPERWORK REDUCTION ACT NOTICE
information by the applicant is mandatory in order to
This request is in accordance with the Paperwork
obtain an amended importer of tobacco products or
Reduction Act of 1995. This application is used to
processed tobacco permit.
determine the eligibility of the applicant to engage in
2. PURPOSE. To identify the applicant, to identify the
certain operations, to determine location and extent of
location where the applicant will conduct business,
operations, and to determine whether the operations will
and to identify changes affecting the accuracy of the
be in conformity with Federal laws and regulations. The
applicant’s original importer of tobacco products or
information requested is mandatory by statute (26
processed tobacco permit.
U.S.C. 5712).
3. ROUTINE USES. The information will be used by
The estimated average burden associated with this
TTB to make the determinations set forth in
collection is 1 hour per respondent or recordkeeper,
paragraph 2. In addition, the information may be
depending on individual circumstances.
disclosed to other Federal, State, foreign and local
Comments concerning the accuracy of this burden
law enforcement and regulatory agency personnel to
estimate and suggestions for reducing this burden
verify the information on the application where such
should be addressed to Reports: Management Officer,
disclosure is not prohibited by law. The information
Regulations and Rulings Division, Alcohol and Tobacco
may further be disclosed to Federal authorities if it
Tax and Trade Bureau, Washington, DC 20220.
appears that the furnishing of false information may
constitute a violation of Federal law. Finally,
An agency may not conduct or sponsor, and an
information may be disclosed to members of the
individual is not required to respond to, a collection of
public in order to verify the information on the
information unless it displays a current valid OMB control
application where such disclosure is not prohibited
number.
by law.
TTB F 5230.5 (02/2010)
PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Instructions: Page 1 of 1
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