TTB Form 5120.24 "Drawback on Wines Exported"

What Is TTB Form 5120.24?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on April 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 April 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 5120.24 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. 1513-0016 (03/31/2013)
1. SERIAL NUMBER (The exporter will number
DEPARTMENT OF THE TREASURY
each form beginning with "1" each January 1.)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
DRAWBACK ON WINES EXPORTED
(See instructions below)
(FOR TTB USE ONLY)
PART I - NOTICE
2. TO
Director, National Revenue Center / Alcohol and Tobacco Tax and Trade Bureau
550 Main St., Ste 8002
CincinnatI, OH 45202-5215
The undersigned gives notice of the shipment of wines manufactured , bottled, or packaged in the United States
CLAIM NUMBER
on which drawback of the Internal Revenue tax paid or determined is claimed.
3. EXPORTER - NAME AND ADDRESS (Number, Street, City, State, Zip Code
4. Permit/Registry Number
DATE RECEIVED
TTB F 5620.4
FILED WITH CLAIM NO.
5. EMPLOYER IDENTIFICATION NUMBER
2
SHIPMENT FOR
TRANSFER TO
(Number)
AMOUNT CLAIMED
(Location)
6. PURPOSE
EXPORT TO ARMED
FOREIGN TRADE
$
OF
FORCES OF THE U.S.
ZONE
AMOUNT REJECTED
SHIPMENT
EXPORTATION TO (Name of foreign port and country)
$
(Make
applicable
AMOUNT APPROVED
entries)
USE AS SUPPLIES ON
A VESSEL
3
AIRCRAFT
3
CLAIMS CLERK
DIRECTOR OF CUSTOMS AT PORT OF
7. CONSIGNED
TO OR IN
8. NAME OF DOMESTIC CARRIER
TRANSPORTATION
(Name)
(Name)
CARE OF
(Location)
OFFICER
(Make
applicable
CUSTOMS OFFICER IN (Number)
9. NAME OF EXPORT CARRIER
(Location)
entries)
CHARGE OF FOREIGN
TRADE ZONE
10. DESCRIPTION OF WINE SHIPPED
CASES
ALC.
TOTAL
KIND
NUMBER
DRAWBACK
SERIAL NUMBERS OF
WINE
OF
OF
CONTENT
BOTTLES
RATE PER WINE
CONTAINERS OR CASES
4
GALLONS
WINE
PACKAGES
GALLON
size
in case
NUMBER
(a)
(b)
(d)
(c)
(e)
(f)
(g)
(h)
(i)
PART II - CLAIM
11. AMOUNT CLAIMED
The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded within
the limits of the United States. The kind, quantity, and description of the wines stated in Part I is correct, and I am
$
justly entitled to drawback of the tax in the amount claimed herein. Internal Revenue tax equal to such amount has been
12. I REQUEST DRAWBACK
paid or determined as provided by law and regulations. No other claim for allowance of drawback has been made under 26
ALLOWED TO BE PAID
U.S.C. 5062(b), or Section 309 of the Tariff Act of 1930, as amended, on these wines or any part thereof. Under penalties of
BY
perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the
statements herein and in Part I, are true, correct, and complete.
CREDIT
CHECK
13. DATE
4. EXPORTER
. SIGNATURE
14b. TITLE
(c) vessel of the United States engaged in trade between Atlantic
(c) vessel of the United States engaged in trade between Atlantic
Insert, as applicable, plant number of distilled spirits plant, registry number of bonded
1
and Pacific ports of the United States; (d) vessel employed in
and Pacific ports of the United States; (sel employed in
wine cellar or taxpaid wine bottling house, or number of the wholesale liquor dealers
country of registry, and ports of call, or if a whaling vessel, location
country (1) the fisheries: or (2) the wd) veshaling business. Sh
permit issued under the Federal Alcohol Administration Act.
of operations. If aircraft, show also name of airline and country of
of vessel, location of operations. If aircraft, show also name of
Complete only for consolidated claims; show serial number of last claim tabulated.
2
airline and country of registry of aircraft.
4
Show filing date when
registry of aircraft.
State whether a (a) vessel or aircraft operated by the United States; (b) vessel or aircraft
3
4
Show filling date when use of such date has been authorized in
engaged in foreign trade, or in trade between the United States and any of its
use of such date has been authorized in lieu of serial numbers o
possessions, or between Hawaii or Alaska and any other part of the United States;
lieu of serial numbers on cases.
TTB F 5120.24 (8/2006)
TB F 5120.24 (0 /20
)
Page 1 of 2
OMB No. 1513-0016 (03/31/2013)
1. SERIAL NUMBER (The exporter will number
DEPARTMENT OF THE TREASURY
each form beginning with "1" each January 1.)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
DRAWBACK ON WINES EXPORTED
(See instructions below)
(FOR TTB USE ONLY)
PART I - NOTICE
2. TO
Director, National Revenue Center / Alcohol and Tobacco Tax and Trade Bureau
550 Main St., Ste 8002
CincinnatI, OH 45202-5215
The undersigned gives notice of the shipment of wines manufactured , bottled, or packaged in the United States
CLAIM NUMBER
on which drawback of the Internal Revenue tax paid or determined is claimed.
3. EXPORTER - NAME AND ADDRESS (Number, Street, City, State, Zip Code
4. Permit/Registry Number
DATE RECEIVED
TTB F 5620.4
FILED WITH CLAIM NO.
5. EMPLOYER IDENTIFICATION NUMBER
2
SHIPMENT FOR
TRANSFER TO
(Number)
AMOUNT CLAIMED
(Location)
6. PURPOSE
EXPORT TO ARMED
FOREIGN TRADE
$
OF
FORCES OF THE U.S.
ZONE
AMOUNT REJECTED
SHIPMENT
EXPORTATION TO (Name of foreign port and country)
$
(Make
applicable
AMOUNT APPROVED
entries)
USE AS SUPPLIES ON
A VESSEL
3
AIRCRAFT
3
CLAIMS CLERK
DIRECTOR OF CUSTOMS AT PORT OF
7. CONSIGNED
TO OR IN
8. NAME OF DOMESTIC CARRIER
TRANSPORTATION
(Name)
(Name)
CARE OF
(Location)
OFFICER
(Make
applicable
CUSTOMS OFFICER IN (Number)
9. NAME OF EXPORT CARRIER
(Location)
entries)
CHARGE OF FOREIGN
TRADE ZONE
10. DESCRIPTION OF WINE SHIPPED
CASES
ALC.
TOTAL
KIND
NUMBER
DRAWBACK
SERIAL NUMBERS OF
WINE
OF
OF
CONTENT
BOTTLES
RATE PER WINE
CONTAINERS OR CASES
4
GALLONS
WINE
PACKAGES
GALLON
size
in case
NUMBER
(a)
(b)
(d)
(c)
(e)
(f)
(g)
(h)
(i)
PART II - CLAIM
11. AMOUNT CLAIMED
The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded within
the limits of the United States. The kind, quantity, and description of the wines stated in Part I is correct, and I am
$
justly entitled to drawback of the tax in the amount claimed herein. Internal Revenue tax equal to such amount has been
12. I REQUEST DRAWBACK
paid or determined as provided by law and regulations. No other claim for allowance of drawback has been made under 26
ALLOWED TO BE PAID
U.S.C. 5062(b), or Section 309 of the Tariff Act of 1930, as amended, on these wines or any part thereof. Under penalties of
BY
perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the
statements herein and in Part I, are true, correct, and complete.
CREDIT
CHECK
13. DATE
4. EXPORTER
. SIGNATURE
14b. TITLE
(c) vessel of the United States engaged in trade between Atlantic
(c) vessel of the United States engaged in trade between Atlantic
Insert, as applicable, plant number of distilled spirits plant, registry number of bonded
1
and Pacific ports of the United States; (d) vessel employed in
and Pacific ports of the United States; (sel employed in
wine cellar or taxpaid wine bottling house, or number of the wholesale liquor dealers
country of registry, and ports of call, or if a whaling vessel, location
country (1) the fisheries: or (2) the wd) veshaling business. Sh
permit issued under the Federal Alcohol Administration Act.
of operations. If aircraft, show also name of airline and country of
of vessel, location of operations. If aircraft, show also name of
Complete only for consolidated claims; show serial number of last claim tabulated.
2
airline and country of registry of aircraft.
4
Show filing date when
registry of aircraft.
State whether a (a) vessel or aircraft operated by the United States; (b) vessel or aircraft
3
4
Show filling date when use of such date has been authorized in
engaged in foreign trade, or in trade between the United States and any of its
use of such date has been authorized in lieu of serial numbers o
possessions, or between Hawaii or Alaska and any other part of the United States;
lieu of serial numbers on cases.
TTB F 5120.24 (8/2006)
TB F 5120.24 (0 /20
)
Page 1 of 2
PART III - CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT
I hereby certify that the wines described in Part I were found as described, except as noted in Item 19, and that the wines were--
(Name)
(Name, symbols, number)
15. LADEN FOR
VESSEL
AIRCRAFT
(Number)
(State license)
USE AS
RAILROAD CAR
TRUCK
EXPORT
SUPPLIES
ON BOARD
17.
RECEIVED IN
NUMBER
SHIPPED TO
16.
SERIAL NUMBER OF SEALS USED
(Frontier Port)
18.
FOREIGN
TRADE ZONE
.
19
DISCREPANCIES
I
INSPECTION DISCLOSED
NO
N
OR SHORT SHIPMENT
NO EVIDENCE OF
DISCREPANCY
T
AS FOLLOWS:
TAMPERING
21 .
PORT
SIGNATURE AND TITLE OF CUSTOMS OFFICER
DATE
22.
20.
PART IV - CUSTOMS OFFICER’S PORT REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
23. FRONTIER PORT
NO EVIDENCE OF TAMPERING
25. INSPECTION DISCLOSED :
24. DATE RECEIVED
SEALS INTACT
SEALS BROKEN
26.
NATURE AND EXTENT OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
27.
FOREIGN PORT
The exporting conveyance noted in Item 15, bearing the wines described in Item 10,
with exceptions as noted in items 20 and 27, cleared from this port for the port of
19 and 26,
SIGNATURE AND TITLE OF CUSTOMS OFFICER
28.
DATE
29.
PART V - CERTIFICATE OF CLEARANCE OR USE
30
. THE EXPORTING CONVEYANCE BEARING THE WINES DESCRIBED IN ITEM 10, WITH EXCEPTIONS AS NOTED ABOVE --
CLEARED FROM THE PORT OF
ON (Date)
BOUND FOR (Foreign port)
31.
THE WINE HAS BEEN USED AS SUPPLIES ON THE
33 .
32.
SIGNATURE OF PORT DIRECTOR OF
DATE
FISHING VESSEL OR AIRCRAFT IDENTIFIED ABOVE,
CUSTOMS
AND THE EVIDENCE OF SUCH USE HAS BEEN
RECEIVED .
PART VI - CERTIFICATE RECEIPT BY ARMED FORCES OFFICER
The wine described in Part I, with exceptions as noted in item 35, were received for export to the Armed Forces of the United States. The wines will
not be shipped for consumption or used in any place subject to the application of the Internal Revenue laws of the United States.
34.
35.
DATE
DISCREPANCIES
36.
37 .
RANK
TITLE
SIGNATURE
38.
INSTRUCTIONS
1. GENERAL. Under 27 CFR 28.212 and 28.214 persons qualified as proprietors of distilled
1. GENERAL. Under 27 CFR 28.212 and 28.214 persons qualified as proprietors of
and forward them to the Port Director of Customs. The Port Director, on receipt of the
distilled spirits plants, bonded wine cellars, or taxpaid wine bottling houses, or holding
spirits plants, bonded wine cellars, or taxpaid wine bottling houses, or holding wholesale liquor
required ”Certificates of Use” (for aircraft) or Customs Form 5125 (for fishing vessels), must
wholesale liquor dealer permits issued under the Federal Alcohol Adminstration Act, are
execute Part V, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade
dealer permits issued under the Federal Alcohol Administration Act, are authorized to file claims
Bureau at the address shown in item 2, and retain the copy for his/her files. (c) Lading at Interior
authorized to file claims on Form 5120.24 for allowance of drawback of Internal Revenue
on Form 5120.24 for allowance of drawback of Internal Revenue taxes.
taxes.
Port For Exportation Through Frontier Port. On completion of lading, the Customs officer
2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy,
will affix the seals, then execute Part III on both copies and forward them to the Port
2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy,
marked “Consignee’s Copy,” where the wine is for use on an aircraft.
Director of Customs at the interior port of lading for forwarding to the Customs officer at the
marked “Consignee’s Copy,” where the wine is for use on an aircraft.
frontier port. That officer, when satisfied that the shipment has been exported, must execute
3. INSTRUCTIONS TO EXPORTER. Complete Part I and execute Part II. A proprietor may
3. INSTRUCTIONS TO EXPORTER. Complete Part I and execute Part II. If you are a
Part IV on both copies and return them to the Port Director of Customs at the interior port.
elect (in item 12) to recoup an approved drawback allowance by check or credit. A check or ACH
proprietor of a bonded wine cellar, you may elect (item 12) to have a drawback allowance
The Port Director will then execute Part V, forward the original to the Director, NRC,
electronic payment will be issued if the "Check" box is marked. An approved credit can be taken
paid either by check or by credit (TTB F 2639), which can be claimed on a subsequent
Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the
as a decreasing adjustment on one or more Excise Tax Returns (Form 5000.24). On shipments
tax return on Form 5000.24; all other claimants should check the box designated “Check”. On
copy for his/her files. (d) Receipt in Foreign Trade Zones. On receipt of the wine, the Customs
shipments of the wine, forward the original and one copy of this form to the official designated in
of the wine, forward the original and one copy of this form to the official designated
officer must execute Part III on both copies, forward the original to the Director, NRC,
Item 7, forward one copy to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau
in Item 7, forward one copy to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau
Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the
at the address shown in item 2, and retain a copy in your files. If a “Consignee’s Copy” has
at the address shown in item 2, and retain a copy in your files. If a “Consignee’s Copy” has
copy for his/her files.
been prepared (see instruction 2), forward it to the airline company at the airport.
been prepared (see instruction 2), forward it to the airline company at the airport.
5. ACTION BY ARMED FORCES OFFICER. On receipt of the wines, the officer to whom
4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other
consigned (or other authorized supply officer) must execute Part VI on both copies, forward
4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other Than
Than Fishing Vessels. After inspection of lading, the Customs officer must execute Part IV,
the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address
Fishing Vessels. After inspection of lading, the Customs officer must execute Part IV, forward
forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the
shown in item 2, and retain the copy for his/her records.
the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address
address shown in item 2, and retain the copy for his/her files. (b) Use on Aircraft and Fishing
shown in item 2, and retain the copy for his/her files. (b) Use on Aircraft and Fishing Vessels.
RETENTION PERIOD: The retention period is three years from the record date or the date
Vessels. After inspection of lading, the Customs officer must execute Part III on both copies
After inspection of lading, the Customs officer must execute Part III on both copies
of the last entry required to be made on the record, whichever is later. The appropriate
TTB officer may require records to be kept an additional period not to exceed three years.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with Paperwork Reduction Act of 1995. This information collection is used to obtain drawback of taxes on wine exported from the United States. The
information is required to obtain a benefit under 26 U.S.C. 5062.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with Paperwork Reduction Act of 1995. This information collection is used to obtain drawback of taxes on wine exported from the United States. The
The estimated average burden associated with this collection of information is 1 hour and 7 minutes per respondent or recordkeeper, depending on individual circumstances.
information is required to obtain a benefit under 26 U.S.C. 5062.
Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Report Management Officer, Regulations and
Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
The estimated average burden associated with this collection of information is 1 hour and 7 minutes per respondent or recordkeeper, depending on individual circumstances. Comments
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.
concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Report Management Officer, Regulations and Rulings Division,
Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
TTB F 5120.24 (7/2006)
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 5120.24 (0 /20
)
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