TTB Form 5110.30 "Drawback on Distilled Spirits Exported"

What Is TTB Form 5110.30?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on May 1, 2009 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2009;
  • 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 5110.30 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. 1513-0042 (04/30/2015)
1. SERIAL NO. (The exporter must
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
number each form beginning with
DRAWBACK ON DISTILLED SPIRITS EXPORTED
"1" each Jan. 1)
(See instructions on Page 2)
PART I - NOTICE
FOR TTB USE ONLY
Notice is hereby given of the shipment of taxpaid distilled spirits which were stamped, restamped, or affixed with
alternative devices and marked especially for export on which drawback of internal revenue tax paid will be
CLAIM NO.
claimed by the bottler or packager.
2. NAME AND ADDRESS OF EXPORTER (Number and Street, City, State, ZIP Code)
DATE REC’D
TTB FORM 5620.4
2
FILED WITH CLAIM NO.
3. NAME AND ADDRESS OF BOTTLER OR PACKAGER
3A. EMPLOYER IDENTIFICATION NUMBER
(Bottler or packager)
CLAIMED
$
REJECTED
4. ADDRESS OF THE DIRECTOR NATIONAL REVENUE CENTER (NRC), ALCOHOL AND TOBACCO TAX
$
AND TRADE BUREAU, 550 MAIN ST, STE 8002, CINCINNATI, OH 45202-5215
ALLOWED
$
(Number)
(Location)
5. PURPOSE
FOR EXPORT TO
TRANSFER TO:
OF
ARMED FORCES OF
CLAIMS CLERK
FOREIGN-TRADE
CBW
REMOVAL
THE UNITED STATES
$
ZONE
EXPORTATION TO (Name of foreign port and country)
(Make
applicable
entries)
1
1
USE AS SUPPLIES ON A VESSEL
ON AIRCRAFT
6. CONSIGNED DISTRICT DIRECTOR OF CUSTOMS AT PORT OF (Specify)
7. NAME OF DOMESTIC CARRIER
TO OR IN
CARE OF
TRANSPORTATION OFFICER (Name)
(Location)
(applicable
8. NAME OF EXPORT CARRIER
entries)
PROPRIETOR
Number
(Location)
FOREIGN-TRADE ZONE
CBW
9. DESCRIPTION OF DISTILLED SPIRITS REMOVED
CASES
WINE GALLONS
(Not required
BOTTLES
KIND
NUMBER
for spirits tax
PROOF
SERIAL NUMBERS OF
OF
OF
IN
determined
SPIRITS
PACKAGES
CASE
PROOF
GALLONS
NUMBER
SIZE
CONTAINERS OR CASES
after 1/1/80)
(h)
(c)
(e)
(f)
(g)
(a)
(b)
(d)
(i)
DATE
EXPORTER
BY (Signature and title)
PART II — DESCRIPTION OF SUPPORTING DOCUMENTS, IF REQUIRED (See Instruction 3)
PACKAGE
DRAWBACK
10.
RECORD OF TAX
BOTTLING TANK
GAUGE
RATE PER
SERIAL NUMBERS OF
DETERMINATION
DUMP BATCH RECORD
RECORD/REPORT
REPORT
PROOF GALLON
CONTAINERS OR CASES
SERIAL NO.
DATE
SERIAL NO.
DATE
SERIAL NO.
DATE
DATE
(f)
(a)
(b)
(e)
(g)
(i)
(c)
(d)
(h)
10a. NAME OF BOTTLER OR PACKAGER
ADDRESS
PLANT NUMBER
PART III — CLAIM
11. AMOUNT CLAIMED
The distilled spirits described In Part I were removed for the purpose stated and are not to be brought back or re-
landed within the limits of the United States. The kind, quantity, and description of the distilled spirits as stated in
Part I are correct. The distilled spirits were bottled or packaged in the United States by me and were stamped,
$
restamped, or affixed with alternative devices and marked especially for export. Supporting documents, if required,
are accurately described in Part II. Internal Revenue tax equal to the amount of drawback claimed has been deter-
12. REQUEST DRAWBACK
mined as provided by law and regulations, and I am justly entitled to drawback of tax in the amount claimed herein.
ALLOWED TO BE PAID BY
No other claim for allowance of drawback has been made under 26 U.S.C. 5062(b) or section 309 of the Tariff
Act of 1930, as amended, on these distilled spirits or any part thereof. Under penalties of perjury, I declare that I
have examined all entries in this form and all supporting documents, and to the best of my knowledge and belief
CHECK
CREDIT
they are true, correct, and complete.
13. DATE
14. BOTTLER OR PACKAGER
14a. BY (Signature and title)
FOOTNOTES
1
State whether (a) vessel or aircraft operated by the United States; (b) ves-
(2) the whaling business. Show name of vessel, country of registry, and
sel or aircraft engaged in foreign trade, or in trade between the United
ports of call, or, if a whaling vessel, location of operations. If aircraft, also
States and any of its possessions, or between Hawaii or Alaska and any
show name of airline and country of registry of aircraft.
2
other part of the United States; (c) vessel of the United States engaged In
Complete only for consolidated claims; show serial number of last claim
trade between Atlantic and Pacific ports of the United States; (d) vessel of
tabulated.
war of any foreign nation; or (e) vessel employed in (1) the fisheries, or
TTB F 5110.30 (05/2009)
Page 1 of 2
OMB No. 1513-0042 (04/30/2015)
1. SERIAL NO. (The exporter must
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
number each form beginning with
DRAWBACK ON DISTILLED SPIRITS EXPORTED
"1" each Jan. 1)
(See instructions on Page 2)
PART I - NOTICE
FOR TTB USE ONLY
Notice is hereby given of the shipment of taxpaid distilled spirits which were stamped, restamped, or affixed with
alternative devices and marked especially for export on which drawback of internal revenue tax paid will be
CLAIM NO.
claimed by the bottler or packager.
2. NAME AND ADDRESS OF EXPORTER (Number and Street, City, State, ZIP Code)
DATE REC’D
TTB FORM 5620.4
2
FILED WITH CLAIM NO.
3. NAME AND ADDRESS OF BOTTLER OR PACKAGER
3A. EMPLOYER IDENTIFICATION NUMBER
(Bottler or packager)
CLAIMED
$
REJECTED
4. ADDRESS OF THE DIRECTOR NATIONAL REVENUE CENTER (NRC), ALCOHOL AND TOBACCO TAX
$
AND TRADE BUREAU, 550 MAIN ST, STE 8002, CINCINNATI, OH 45202-5215
ALLOWED
$
(Number)
(Location)
5. PURPOSE
FOR EXPORT TO
TRANSFER TO:
OF
ARMED FORCES OF
CLAIMS CLERK
FOREIGN-TRADE
CBW
REMOVAL
THE UNITED STATES
$
ZONE
EXPORTATION TO (Name of foreign port and country)
(Make
applicable
entries)
1
1
USE AS SUPPLIES ON A VESSEL
ON AIRCRAFT
6. CONSIGNED DISTRICT DIRECTOR OF CUSTOMS AT PORT OF (Specify)
7. NAME OF DOMESTIC CARRIER
TO OR IN
CARE OF
TRANSPORTATION OFFICER (Name)
(Location)
(applicable
8. NAME OF EXPORT CARRIER
entries)
PROPRIETOR
Number
(Location)
FOREIGN-TRADE ZONE
CBW
9. DESCRIPTION OF DISTILLED SPIRITS REMOVED
CASES
WINE GALLONS
(Not required
BOTTLES
KIND
NUMBER
for spirits tax
PROOF
SERIAL NUMBERS OF
OF
OF
IN
determined
SPIRITS
PACKAGES
CASE
PROOF
GALLONS
NUMBER
SIZE
CONTAINERS OR CASES
after 1/1/80)
(h)
(c)
(e)
(f)
(g)
(a)
(b)
(d)
(i)
DATE
EXPORTER
BY (Signature and title)
PART II — DESCRIPTION OF SUPPORTING DOCUMENTS, IF REQUIRED (See Instruction 3)
PACKAGE
DRAWBACK
10.
RECORD OF TAX
BOTTLING TANK
GAUGE
RATE PER
SERIAL NUMBERS OF
DETERMINATION
DUMP BATCH RECORD
RECORD/REPORT
REPORT
PROOF GALLON
CONTAINERS OR CASES
SERIAL NO.
DATE
SERIAL NO.
DATE
SERIAL NO.
DATE
DATE
(f)
(a)
(b)
(e)
(g)
(i)
(c)
(d)
(h)
10a. NAME OF BOTTLER OR PACKAGER
ADDRESS
PLANT NUMBER
PART III — CLAIM
11. AMOUNT CLAIMED
The distilled spirits described In Part I were removed for the purpose stated and are not to be brought back or re-
landed within the limits of the United States. The kind, quantity, and description of the distilled spirits as stated in
Part I are correct. The distilled spirits were bottled or packaged in the United States by me and were stamped,
$
restamped, or affixed with alternative devices and marked especially for export. Supporting documents, if required,
are accurately described in Part II. Internal Revenue tax equal to the amount of drawback claimed has been deter-
12. REQUEST DRAWBACK
mined as provided by law and regulations, and I am justly entitled to drawback of tax in the amount claimed herein.
ALLOWED TO BE PAID BY
No other claim for allowance of drawback has been made under 26 U.S.C. 5062(b) or section 309 of the Tariff
Act of 1930, as amended, on these distilled spirits or any part thereof. Under penalties of perjury, I declare that I
have examined all entries in this form and all supporting documents, and to the best of my knowledge and belief
CHECK
CREDIT
they are true, correct, and complete.
13. DATE
14. BOTTLER OR PACKAGER
14a. BY (Signature and title)
FOOTNOTES
1
State whether (a) vessel or aircraft operated by the United States; (b) ves-
(2) the whaling business. Show name of vessel, country of registry, and
sel or aircraft engaged in foreign trade, or in trade between the United
ports of call, or, if a whaling vessel, location of operations. If aircraft, also
States and any of its possessions, or between Hawaii or Alaska and any
show name of airline and country of registry of aircraft.
2
other part of the United States; (c) vessel of the United States engaged In
Complete only for consolidated claims; show serial number of last claim
trade between Atlantic and Pacific ports of the United States; (d) vessel of
tabulated.
war of any foreign nation; or (e) vessel employed in (1) the fisheries, or
TTB F 5110.30 (05/2009)
Page 1 of 2
PART IV — CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT
I certify that the distilled spirits described in Part I were found to be as described, except as noted in Item 18, and that the distilled spirits were --
15. LADEN FOR
VESSEL (Name)
AIRCRAFT (Name, symbols, number)
EXPORT
USE AS
RAILROAD CAR (Number)
TRUCK (State license)
SUPPLIES
16.
RECEIVED IN
(Number)
17. SHIPPED TO (Frontier port)
SERIAL NUMBERS OF SEALS USED
FOREIGN-
CBW
TRADE ZONE
18. INSPECTION DISCLOSED
NO EVIDENCE
NO DISCREPANCY OR SHORT
OF TAMPERING
SHORT SHIPMENT, AS FOLLOWS:
19. DATE
20. PORT
21. SIGNATURE AND TITLE OF PROPRIETOR
PART V — CUSTOMS OFFICER'S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
22. FRONTIER PORT
23. DATE RECEIVED
24. INSPECTION DISCLOSED
SEALS
SEALS BROKEN
NO EVIDENCE
INTACT
OF TAMPERING
(See Item 25)
25. DETAILS OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
26. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 15, BEARING THE SPIRITS
DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED IN ITEMS 18 AND 25, CLEARED
FROM THIS PORT FOR THE PORT OF
(Foreign port)
27. DATE
28. SIGNATURE AND TITLE OF CUSTOMS OFFICER
PART VI - CERTIFICATE OF CLEARANCE OR USE
29. THE EXPORTING CONVEYANCE BEARING THE SPIRITS DESCRIBED IN ITEM 9 WITH EXCEPTIONS AS NOTED ABOVE CLEARED FROM
THE PORT OF
ON (Date)
BOUND FOR (Name of foreign port and country)
30.
THE DISTILLED SPIRITS HAVE BEEN USED AS
31. DATE
32. SIGNATURE OF DISTRICT DIRECTOR OF CUSTOMS
SUPPLIES ON THE FISHING VESSEL OR AIR-
CRAFT IDENTIFIED ABOVE, AND THE REQUIRED
EVIDENCE OF SUCH USE HAS BEEN RECEIVED
PART VII — CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
The distilled spirits described in Item 9, with exceptions as noted in Item 34, were received for export to the Armed Forces of the United States. The distilled
spirits will not be shipped for consumption or use in any place subject to application of the internal revenue laws of the United States.
33. DATE
34. DISCREPANCIES
35. SIGNATURE
36. RANK
37. TITLE
INSTRUCTIONS
1. General. Prepare this form in quadruplicate, except prepare a fifth
Claims must be filed with the Director, NRC, by the bottler or packager and
copy, marked "Consignee's Copy," when the shipment is for use on aircraft.
must be accompanied by the necessary supporting documents.
2. Part I. The exporter must complete Part I.
6. Action By Customs. (a) Shipments For Direct Exportation, or Use on
3. Part II. The bottler or packager must complete Part II if the spirits were
Vessels Other Than Fishing Vessels. After inspection of lading, the Cus-
tax-determined before January 1, 1980 (see (a), below) or if the spirits
toms officer must execute Part IV on both copies and forward them to the
were tax-determined after January 1, 1980 and the drawback rate exceeds
District Director of Customs. On clearance of the conveyance, the District
Director of Customs must execute Part VI, forward the original to the
$10.50 per proof gallon (see (b), below).
Director NRC, Alcohol and Tobacco Tax and Trade Bureau at the address
(a) Spirits tax-determined before January 1, 1980. Claims for spirits
shown in item 4 and retain the copy for his/her files.
tax-determined before January 1, 1980, must be supported by a copy of
(b) Use on Aircraft and Fishing Vessels. After inspection of lading,
each related dump and batch record, bottling tank report, and/or package
the Customs officer must execute Part IV on both copies and forward them
gauge report covering the processing, bottling, and/or packaging of the
to the District Director of Customs. The District Director of Customs, on
spirits. Claims on spirits bottled in bond on bonded premises before Janu-
receipt of the required "Certificate of Use" (for aircraft) or Customs Form
ary 1, 1980, must be supported by a copy of ATF Form 179 covering the
5125 (for fishing vessels), must execute Part VI, forward the original to the
tax-determination of the spirits. These supporting documents must be iden-
Director, NRC, Alcohol and Tobacco Tax and Trade Bureau, at the ad-
tified In the appropriate columns in Part II, along with the drawback rate for
dress shown in item 4, and retain the copy for his/her files.
each product. If a standard drawback rate was established prior to January
(c) Lading at Interior Port For Exportation Through Frontier Port. On
1, 1980, the date of approval of the formula and the number must be
completion of lading the Customs officer must affix the seal, then execute
shown in any available space in Part II. If the claim covers the products
Part IV on both copies and forward them to the District Director of Customs
made with imported spirits (other than such spirits withdrawn from internal
at the interior port of lading for forwarding to the Customs officer at the
revenue bond) or imported wines, the claimant must furnish evidence of
frontier port. Provided that where the shipment is by truck and where in-
tax payment for the spirits or wines (such as Customs Forms 7505 or 7501
structions from the District Director of Customs so provide, the copies may
receipted to indicate the payment of taxes).
be forwarded via the truck driver to the Customs officer at the frontier port.
(b) Spirits tax-determined after January 1, 1980, and the drawback
That officer, when satisfied that the shipment has been exported, must
rate exceeds $10.50 per proof gallon. Claims for these spirits must be
execute Part V on both copies and return them to the District Director of
supported by a copy of each related dump and batch record, bottling tank
Customs at the interior port. The District Director of Customs must then
record, and/or package gauge report covering the processing, bottling, and/
execute Part VI, forward the original to the Director, NRC, Alcohol and
or packaging of the spirits. If the claim covers products made with imported
Tobacco Tax and Trade Bureau, at the address shown in item 4, and retain
spirits (other than such spirits withdrawn from internal revenue bond) or
the copy for his/her files.
imported wines, the claimant must furnish evidence of tax payment for the
(d) Receipt in Foreign - Trade Zone. On receipt of the spirits, the Cus-
spirits or wines (such as Customs Forms 7505 or 7501 receipted to indi-
toms officer must execute Part IV on both copies, forward the original to
cate the payment of taxes).
the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau, at the
4. Part III. The bottler or packager must complete Part III and indicate in
address shown In item 4, and retain the copy for his/her files.
Item 12 whether the claim is for a check remittance or a credit to be taken
(e) Receipt in Customs Bonded Warehouse. On receipt of the ship-
on the distilled spirits tax return, TTB F 5000.24. In addition to supporting
ment, the Customs officer must execute Part IV on both copies, forward the
documents required in some cases (see Part II, above), all claims must be
original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau,
supported by the bill of lading required by 27 CFR 28.250. For spirits tax-
and keep a copy for his/her files.
determined after January 1, 1980, all claims must be supported by an in-
7. Action by Armed Forces Officer. On receipt of the spirits, the officer
voice, bill of lading, or other document which identifies the date of tax-
to whom consigned (or other authorized supply officer) must execute Part
determination, unless the bill of lading, required by 27 CFR 28.250 identi-
VII on both copies, forward the original to the Director, NRC, Alcohol and
fies this date.
Tobacco Tax and Trade Bureau, at the address shown in item 4, and retain
5. Distribution. On removal of the spirits, the exporter must forward the
the copy for his/her files.
original and one copy to the official designated in Item 6. If there is a
"Consignee's Copy" (see Instruction No. 1), the exporter must forward it to
the airline company at the airport. If the exporter is not the bottler or pack-
ager, he/she must furnish two copies to the bottler or packager.
Page 2 of 2
TTB F 5110.30 (05/2009)
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the, Paperwork Reduction Act of 1995. The information collection is used to obtain drawback of taxes on
articles which are exported. This information is required to obtain a benefit (26 U.S.C. 5062).
The estimated average burden associated with this collection of information is 2 hours 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, Washington, DC 20220.
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.
TTB F 5110.30 (05/2009)
Page of 3