TTB Form 5120.20 "Certificate of Tax Determination - Wine"

What Is TTB Form 5120.20?

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, 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 January 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 5120.20 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 5120.20 "Certificate of Tax Determination - Wine"

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Rate (4.8 / 5) 42 votes
OMB No. 1513-0029 (01/31/2013)
FILED IN SUPPORT OF
DEPARTMENT OF THE TREASURY
TTB F 5120.24
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
NO.
CERTIFICATE OF TAX DETERMINATION - WINE
or Claim F 5620.8.
(See Paperwork Reduction Act Notice Below)
PART I - STATEMENT OF EXPORTER
I am the exporter of wines described below, and intend to file claim for drawback of tax thereon.
A C
CASES
NO.
SERIAL NUMBERS
L O
KINDS OF
WINE GALLONS
(Show fi ling date when use of such date
OF
BOTTLES
C N
WINES
O T
PACK-
NUMBER
TRADE OR
has been authorized in lieu of serial
PER
H E
OF CASES
numbers on cases)
AGES
SIZE
BRAND NAME
O N
CS.
L T
(a)
(b)
(c)
(e)
(f
(h
(d)
1. DATE
2. EXPORTER (Name and Address)
3. BY (Signature and Title)
3. BY (Signature and Title)
1. DATE
2. EXPORTER (Name and Address)
PART II - REQUEST OF EXPORTER FOR CERTIFICATE
4a. TO: (Name and Address)
4b. My records indicate that the above described wines were:
Withdrawn by you on
Bottled or packaged by you
determination of tax
after determination of tax
Please execute the certificate (Part III) on all copies of
this form, and return the original and one copy to me at
the address shown above.
PART III - CERTIFICATE
5. Under penalties of perjury, I certify that the wines described above were manufactured or produced in the United States and were:
Bottled or packaged while in bond, and
Withdrawn from bond by me on determination of
were then withdrawn from bond by me on
tax and were then bottled or packaged by me.
determination of tax.
Bottled or packaged by me after they
were received in taxpaid status from:
( NAME, ADDRESS , AND
OR PERMIT NUMBER)
This certificate is executed with the knowledge that it will be used in support of a claim against the United States for drawback of tax.
6. DATE
7. DEPONENT (Name and Address)
8. BY (Signature and Title)
9.
OR
NO.
INSTRUCTIONS
1. A certificate of tax determination must be executed on this form to support a claim
be executed only (a) by the person who withdrew the wine from bond on determination
filed by an exporter for drawback of tax on wines exported from the United States,
of tax, or (b) if the wine was bottled or packaged after tax determination, by the person
laden for use as supplies on certain vessels or aircraft, transferred to a foreign-trade
who bottled or packaged it.
zone, or transferred for export to Armed Forces of the United States. Prepare an
original and two copies of the form (original and one if the exporter and the person
3. The exporter is responsible for securing a properly executed certificate. The
original of the form must be submitted to the Director, National Revenue Center, 550
executing Part III of the form are the same).
Main St, Ste 8002, Cincinnati, OH 45202-5215. A copy of the form must be retained
2. Part III of the form is for certifying that the wines were produced or manufactured in
by the exporter and by the person who executes Part III for 3 years.
the United States and were properly tax paid on withdrawal from bond. This part may
TTB F 5120.20 (
/20 0)
OMB No. 1513-0029 (01/31/2013)
FILED IN SUPPORT OF
DEPARTMENT OF THE TREASURY
TTB F 5120.24
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
NO.
CERTIFICATE OF TAX DETERMINATION - WINE
or Claim F 5620.8.
(See Paperwork Reduction Act Notice Below)
PART I - STATEMENT OF EXPORTER
I am the exporter of wines described below, and intend to file claim for drawback of tax thereon.
A C
CASES
NO.
SERIAL NUMBERS
L O
KINDS OF
WINE GALLONS
(Show fi ling date when use of such date
OF
BOTTLES
C N
WINES
O T
PACK-
NUMBER
TRADE OR
has been authorized in lieu of serial
PER
H E
OF CASES
numbers on cases)
AGES
SIZE
BRAND NAME
O N
CS.
L T
(a)
(b)
(c)
(e)
(f
(h
(d)
1. DATE
2. EXPORTER (Name and Address)
3. BY (Signature and Title)
3. BY (Signature and Title)
1. DATE
2. EXPORTER (Name and Address)
PART II - REQUEST OF EXPORTER FOR CERTIFICATE
4a. TO: (Name and Address)
4b. My records indicate that the above described wines were:
Withdrawn by you on
Bottled or packaged by you
determination of tax
after determination of tax
Please execute the certificate (Part III) on all copies of
this form, and return the original and one copy to me at
the address shown above.
PART III - CERTIFICATE
5. Under penalties of perjury, I certify that the wines described above were manufactured or produced in the United States and were:
Bottled or packaged while in bond, and
Withdrawn from bond by me on determination of
were then withdrawn from bond by me on
tax and were then bottled or packaged by me.
determination of tax.
Bottled or packaged by me after they
were received in taxpaid status from:
( NAME, ADDRESS , AND
OR PERMIT NUMBER)
This certificate is executed with the knowledge that it will be used in support of a claim against the United States for drawback of tax.
6. DATE
7. DEPONENT (Name and Address)
8. BY (Signature and Title)
9.
OR
NO.
INSTRUCTIONS
1. A certificate of tax determination must be executed on this form to support a claim
be executed only (a) by the person who withdrew the wine from bond on determination
filed by an exporter for drawback of tax on wines exported from the United States,
of tax, or (b) if the wine was bottled or packaged after tax determination, by the person
laden for use as supplies on certain vessels or aircraft, transferred to a foreign-trade
who bottled or packaged it.
zone, or transferred for export to Armed Forces of the United States. Prepare an
original and two copies of the form (original and one if the exporter and the person
3. The exporter is responsible for securing a properly executed certificate. The
original of the form must be submitted to the Director, National Revenue Center, 550
executing Part III of the form are the same).
Main St, Ste 8002, Cincinnati, OH 45202-5215. A copy of the form must be retained
2. Part III of the form is for certifying that the wines were produced or manufactured in
by the exporter and by the person who executes Part III for 3 years.
the United States and were properly tax paid on withdrawal from bond. This part may
TTB F 5120.20 (
/20 0)
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collected is used to support a claim filed by an
exporter for drawback of tax on wine exported from the United States. This information is mandatory by 26 U.S.C. 5062.
The estimated average burden associated with this collection of information is .5 hour per respondent or recordkeeper, depending on individual circum-
stances. 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 5120.20 (
/20 0)
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