TTB Form 5110.41 "Registration of Distilled Spirits Plant"

What Is TTB Form 5110.41?

This is a legal form that was released by the U.S. Department of the Treasury - Alcohol and Tobacco Tax and Trade Bureau on November 1, 2016 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2016;
  • 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 5110.41 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. 1513-0048
1. SERIAL NUMBER (Begin with "1"
DEPARTMENT OF THE TREASURY
for original registration)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REGISTRATION OF DISTILLED SPIRITS PLANT
(Prepare in duplicate. See instructions below.)
2.EIN
PART I - APPLICATION
TO: DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND
5. PLANT NUMBER
3.
4. DATE
TOBACCO TAX AND TRADE BUREAU
NAME AND PRINCIPAL BUSINESS ADDRESS OF APPLICANT
PLANT ADDRESS (If different from address in Item 6 )
6.
7.
(Name and street, city, county, State, and ZIP code. If rural address,
show county, name or number of highway, approximate distance
and direction from applicant's post office, and ZIP code.)
OPERATIONS TO BE CONDUCTED (Check applicable boxes)
8.
DISTILLER
WAREHOUSEMAN
PROCESSOR WHO:
DENATURES
BOTTLES
MANUFACTURES ARTICLES
PURPOSE FOR WHICH FILED (Such as original registration, extension of premises, changes in equipment, etc. Give brief description of
9.
changes)
I am
or am not
required to furnish a bond under 27 CFR 19.151. I am not required to furnish a bond only if all of the following are
10.
true: I will withdraw spirits for deferred payment of tax under 27 CFR 19.235, I was liable for not more than $50,000 in distilled spirits taxes
in the preceding calendar year, I reasonably expect to be liable for not more than $50,000 in such taxes during the current calendar year,
and I have no operations or withdrawals involving spirits for industrial use.
11. This application includes: (1) this form; (2) the papers and documents (including revisions) which are being submitted for the first time,
and which are listed in Items 11A and 11B; (3) the current papers and documents of the latest approved Form TTB 5110.41,
Serial No. ___________, which are listed in Items 11A-1 and 11B-1; and (4) the supporting organizational documents filed in connection
with another establishment but incorporated in this application by reference, and listed below in Item 11C.
11A-1. PAGES FROM CURRENT APPROVED FORM TTB F 5110.41:
11A. PAGES ATTACHED TO THIS FORM:
11B. ORGANIZATIONAL DOCUMENTS ATTACHED TO THIS FORM:
11B-1. ORGANIZATIONAL DOCUMENTS FILED WITH PRIOR
(List each document)
APPROVED FORM TTB F 5110.41: (List each document)
11C. ORGANIZATIONAL DOCUMENTS FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT BUT INCORPORATED IN THIS APPLICA-
TION BY REFERENCE: (List each document, and show the name or plant number under which filed)
Under penalties of perjury, I declare that I have examined this application, including accompanying documents, statement of security, and those
documents incorporated in the application by reference, and to the best of my knowledge and belief it is true, correct, and complete.
12. SIGNATURE
13. TITLE
PART II - NOTICE OF REGISTRATION
Registration is approved, effective __________________________________________________________, ________
SIGNATURE AND TITLE OF TTB OFFICIAL, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
DATE
TTB F 5110.41 (11/2016)
OMB No. 1513-0048
1. SERIAL NUMBER (Begin with "1"
DEPARTMENT OF THE TREASURY
for original registration)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REGISTRATION OF DISTILLED SPIRITS PLANT
(Prepare in duplicate. See instructions below.)
2.EIN
PART I - APPLICATION
TO: DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND
5. PLANT NUMBER
3.
4. DATE
TOBACCO TAX AND TRADE BUREAU
NAME AND PRINCIPAL BUSINESS ADDRESS OF APPLICANT
PLANT ADDRESS (If different from address in Item 6 )
6.
7.
(Name and street, city, county, State, and ZIP code. If rural address,
show county, name or number of highway, approximate distance
and direction from applicant's post office, and ZIP code.)
OPERATIONS TO BE CONDUCTED (Check applicable boxes)
8.
DISTILLER
WAREHOUSEMAN
PROCESSOR WHO:
DENATURES
BOTTLES
MANUFACTURES ARTICLES
PURPOSE FOR WHICH FILED (Such as original registration, extension of premises, changes in equipment, etc. Give brief description of
9.
changes)
I am
or am not
required to furnish a bond under 27 CFR 19.151. I am not required to furnish a bond only if all of the following are
10.
true: I will withdraw spirits for deferred payment of tax under 27 CFR 19.235, I was liable for not more than $50,000 in distilled spirits taxes
in the preceding calendar year, I reasonably expect to be liable for not more than $50,000 in such taxes during the current calendar year,
and I have no operations or withdrawals involving spirits for industrial use.
11. This application includes: (1) this form; (2) the papers and documents (including revisions) which are being submitted for the first time,
and which are listed in Items 11A and 11B; (3) the current papers and documents of the latest approved Form TTB 5110.41,
Serial No. ___________, which are listed in Items 11A-1 and 11B-1; and (4) the supporting organizational documents filed in connection
with another establishment but incorporated in this application by reference, and listed below in Item 11C.
11A-1. PAGES FROM CURRENT APPROVED FORM TTB F 5110.41:
11A. PAGES ATTACHED TO THIS FORM:
11B. ORGANIZATIONAL DOCUMENTS ATTACHED TO THIS FORM:
11B-1. ORGANIZATIONAL DOCUMENTS FILED WITH PRIOR
(List each document)
APPROVED FORM TTB F 5110.41: (List each document)
11C. ORGANIZATIONAL DOCUMENTS FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT BUT INCORPORATED IN THIS APPLICA-
TION BY REFERENCE: (List each document, and show the name or plant number under which filed)
Under penalties of perjury, I declare that I have examined this application, including accompanying documents, statement of security, and those
documents incorporated in the application by reference, and to the best of my knowledge and belief it is true, correct, and complete.
12. SIGNATURE
13. TITLE
PART II - NOTICE OF REGISTRATION
Registration is approved, effective __________________________________________________________, ________
SIGNATURE AND TITLE OF TTB OFFICIAL, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
DATE
TTB F 5110.41 (11/2016)
GENERAL INSTRUCTION
1. Application for registration (or amended registration) of a distilled
to bring the notice of registration up to date. Replacement pages must
spirits plant must be submitted on this form, in duplicate, to the
be numbered to correspond to the pages being replaced.
Director, National Revenue Center, 550 Main St, Ste 8002,
Cincinnati, OH 45202-5215. The application when
3. For a partnership, the application must be signed by all partners, or
approved constitutes the notice of registration required by law
by a partner authorized to sign on behalf of the firm, or by an
(26 U.S.C. 5171(c)) to be held before the operations of distiller,
authorized attorney. For a corporation, the application must be
warehouseman, processor, or any combination thereof, may be
executed in the corporate name, followed by the signature and title
commenced or continued.
of the person authorized to act for the corporation.
2. The proprietor is responsible for keeping information in his/her
4. A current notice of registration must be maintained at the plant by
notice of registration current and complete. When a change
the proprietor.
affects the notice, the proprietor must, as required by 27 CFR
Part 19, submit an application for amended registration, together
with supplemental or replacement pages, or documents necessary
PAPERS AND DOCUMENTS TO BE SUBMITTED WITH APPLICATION
1. Applicants are required to furnish, in duplicate, as prescribed in 27
g. Statement of physical security measures employed (see 27 CFR 19.76).
CFR Part 19, the following information on consecutively numbered,
h. As applicable, the following;
dated, looseleaf pages assembled under this form;
(1) For the operations of a distiller:
a. List of applicant's operating and basic permits and the
(a) Statement of daily producing capacity;
operations, withdrawal, or unit bonds, and the penal sums
(b) Statement of production procedure;
thereof (including those filed with this application), with the
(2) For the operations of a warehouseman;
name of the surety or sureties. Note--If the bond(s) is in an
(a) Description of the storage operation;
amount less than the maximum penal sum, applicants must
(3) For the operations of a processor:
include a statement of the maximum number of proof gallons
(a) Statement whether bottling operations will be
which will be stored on, and in transit to such bonded premises
conducted;
during any 15 day period. Information related to bonds need
(b) Statement whether denaturing operations will be con-
not be provided if no bond is required under 27 CFR 19.151.
ducted;
(c) Statement whether articles will be manufactured;
b. List of the offices whose incumbents are authorized by the
(d) Statement whether spirits will be redistilled;
articles of incorporation or the board of directors to act on behalf
(e) Description of the system for storage of spirits
of the proprietor, or to sign his name.
products bottled and cased or otherwise packaged or
c. A statement of the type of business organization and of the
placed in approved containers for removal from
persons interested in the business, supported by the corporate
bonded premises.
documents, articles of partnership, and statement of interest in
(4) For any other business to be conducted on the plant
the business, as required by 27 CFR Part 19. (Where any
premises, a description of the business, a list of the
statement or document required by this paragraph is on file with
buildings and equipment to be used, and a statement
the Director, NRC, it may, by reference thereto by the applicant,
of the relationship, if any, of the business to distilled
be made a part of the registration application.)
spirits operations at the plant.
d. Description of the distilled spirits plant.
e. List of major equipment.
2. Applicants, when instructed by the Director, NRC are required to
f. A certified statement that relevant and material accounting records
furnish as part of the registration application such additional
will be in accordance with generally accepted accounting prin-
information as may be necessary for the Director, NRC to
ciples which enable the proprietor to file a correct distilled spirits
determine whether the application should be approved.
tax return and to determine whether he/she is liable for distilled
spirits taxes.
PRIVACY ACT INFORMATION
The following information is provided pursuant to Section 3 of the Privacy Act of 1974 (5 U.S.C. §552a(e)(3)):
1. AUTHORITY. Solicitation of this information is made pursuant to 26 U.S.C. §5172. Disclosure of this information by the applicant is
mandatory if the applicant wishes to register his distilled spirits plant.
2. PURPOSE. To identify the applicant, to identify the nature, location, and extent of the premises, and the specific type or types of opera-
tions to be conducted on the premises, and to determine the eligibility of the applicant to register the plant.
3. ROUTINE USES. The information will be used by TTB to make determinations set forth in paragraph 2. In addition, the information may
be disclosed to other Federal, State, foreign, and local law enforcement and regulatory agency personnel to verify information on the form
where such disclosure is not prohibited by law. The information may further be disclosed to the Justice Department if it appears that the
furnishing of false information may constitute a violation of Federal law. Finally, the information may be disclosed to members of the
public in order to verify the information on the form where such disclosure is not prohibited by law.
4. EFFECTS OF NOT SUPPLYING REQUESTED INFORMATION. Failure to supply complete information will delay processing and may
result in the denial of the application.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine the eligibilty of the
applicant to engage in certain operations, to determine location and extent of operations, and to determine whether the operations will be in
conformity with Federal laws and regulations. The information requested is required to obtain or retain a benefit and is mandatory by statute
(26 U.S.C. 5172).
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, 1310 G
Street, NW, Box 12, Washington, DC 20005.
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 5110.41 (11/2016)
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