TTB Form 5100.11 "Withdrawal of Spirits, Specially Denatured Spirits, or Wines for Exportation"

What Is TTB Form 5100.11?

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 5100.11 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. 1513-0037
DEPARTMENT OF THE TREASURY
1. SERIAL NO. (Begin with
“1” each Jan. 1)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
WITHDRAWAL OF SPIRITS, SPECIALLY DENATURED SPIRITS, OR WINES FOR EXPORTATION
Please read Instructions after Page 3 before completing this form.
PART I - APPLICATION OR NOTICE
2. APPLICATION IS MADE TO
3. NOTICE GIVEN OF
WITHDRAW SPIRITS OR WINES
WITHDRAWAL OF SPECIALLY
WITHDRAWAL OF SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
DENATURED SPIRITS FREE OF TAX
WITHOUT PAYMENT OF TAX
4. WITHDRAWAL FROM
OPERATED BY
5. ADDRESS OF DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
BW. ______________________
550 MAIN ST, STE 8002
DSP. _______________________
CINCINNATI, OH 45202-5215
6. PURPOSE
SHIPMENT FOR
FOR EXPORTATION TO (Name the foreign port and country) TRANSFER TO (Number or name and location)
OF WITH-
EXPORT TO ARMED
DRAWAL
FORCES OF THE U.S.
CMBW
FTZ
CBW
(Make
Applicable
Entries)
1/
1/
USE AS SUPPLIES ON VESSELS
AIRCRAFT
7. CONSIGNED TO OR IN CARE OF (Make applicable entries)
DIRECTOR OF CUSTOMS AT PORT OF (Specify)
TRANSPORTATION OFFICER (Name) (Location)
CUSTOMS OFFICER/WAREHOUSE PROPRIETOR OF
CMBW
FTZ
CBW
(Location)
8. NAME OF DOMESTIC CARRIER
9. NAME OF EXPORT CARRIER
10. DESCRIPTION OF SPIRITS OR DENATURED SPIRITS AND CONTAINERS (Columns a, d, e, and f only are required for denatured spirits)
3/
PRODUCED BY
FILLED BY
CONTAINERS
PG
2 /
KIND
NAME
DSP NO.
IDENTIFICATION
WG
NO. AND TYPE
(a)
(b)
(c)
(d)
(e)
(f)
Select this checkbox if you need to add additional description of spirits or denatured spirits and containers.
11. DESCRIPTION OF WINES AND CONTAINERS
CONTAINERS
PERCENT
BOTTLES
SIZE OF
WINE
TAX
KIND
4/
ALCOHOL
NO. AND TYPE
SERIAL NUMBER
PER CASE
BOTTLES
GALLONS
LIABILITY
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Select this checkbox if you need to add additional description of wine and containers.
Under the penalties of perjury, I declare that the spirits, denatured spirits, or wines described above are truly intended to (or have been) withdrawn for the purpose
indicated, in the manner prescribed in regulations, and will not be (have not been) shipped for the purpose of evading or delaying payment of any revenue tax thereon.
5/
12. DATE
13. PRINCIPAL
13a. SIGNATURE
13b. TITLE
FOR TTB USE ONLY PART II - APPROVAL OF APPLICATION
14. DATE
15. SIGNATURE AND TITLE OF APPROVING OFFICER
1/ State whether (a) vessel or aircraft operated by the United Slates; (b) vessel or aircraft engaged in foreign trade, or in trade between the United States and any of its possessions, or between
Hawaii or Alaska and any other part of the United states; (c) vessel of the United States engaged in trade between Atlantic and Pacific ports of the United Slates; (d) vessel of war of any foreign
nation; or (e) vessel employed in: (1) the fisheries; or (2) the whaling business. Show name of vessel, country of registry, and ports of call, or, if a whaling vessel, location of operations. If aircraft,
show also name of airline and country of registry of aircraft.
2/ Also enter formula number for special denatured spirits.
3/ Enter quantity of spirits in proof gallons or quantity of denatured spirits in wine gallons and check applicable box.
4/ In Items 11(d) and 22 show filling date when use of that date is authorized instead of serial numbers on cases. Item 11(d) need not be completed when prior approval of application is required.
5/ Show principal on bond under which withdrawal is made. Do not complete this section if the exporter is exempt from bond requirements under 27 CFR 28.51(b). An exporter is exempt only if all of the following are true: the distilled spirits or wine to be
exported is for nonindustrial use; the exporter is a taxpayer (as defined in § 28.51(c)) who reasonably expects to be liable for not more than $50,000 in taxes described in 26 U.S.C. 5061(d)(4) during the current calendar year; the exporter was liable for not
more than $50,000 in such taxes in the preceding calendar year; and the exporter pays such taxes on a deferred basis using a semimonthly, quarterly, or annual return period as described in 26 U.S.C. 5061(d).
TTB F 5100.11 (11/2016)
Page 1 of 3
Reset Form
OMB No. 1513-0037
DEPARTMENT OF THE TREASURY
1. SERIAL NO. (Begin with
“1” each Jan. 1)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
WITHDRAWAL OF SPIRITS, SPECIALLY DENATURED SPIRITS, OR WINES FOR EXPORTATION
Please read Instructions after Page 3 before completing this form.
PART I - APPLICATION OR NOTICE
2. APPLICATION IS MADE TO
3. NOTICE GIVEN OF
WITHDRAW SPIRITS OR WINES
WITHDRAWAL OF SPECIALLY
WITHDRAWAL OF SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
DENATURED SPIRITS FREE OF TAX
WITHOUT PAYMENT OF TAX
4. WITHDRAWAL FROM
OPERATED BY
5. ADDRESS OF DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
BW. ______________________
550 MAIN ST, STE 8002
DSP. _______________________
CINCINNATI, OH 45202-5215
6. PURPOSE
SHIPMENT FOR
FOR EXPORTATION TO (Name the foreign port and country) TRANSFER TO (Number or name and location)
OF WITH-
EXPORT TO ARMED
DRAWAL
FORCES OF THE U.S.
CMBW
FTZ
CBW
(Make
Applicable
Entries)
1/
1/
USE AS SUPPLIES ON VESSELS
AIRCRAFT
7. CONSIGNED TO OR IN CARE OF (Make applicable entries)
DIRECTOR OF CUSTOMS AT PORT OF (Specify)
TRANSPORTATION OFFICER (Name) (Location)
CUSTOMS OFFICER/WAREHOUSE PROPRIETOR OF
CMBW
FTZ
CBW
(Location)
8. NAME OF DOMESTIC CARRIER
9. NAME OF EXPORT CARRIER
10. DESCRIPTION OF SPIRITS OR DENATURED SPIRITS AND CONTAINERS (Columns a, d, e, and f only are required for denatured spirits)
3/
PRODUCED BY
FILLED BY
CONTAINERS
PG
2 /
KIND
NAME
DSP NO.
IDENTIFICATION
WG
NO. AND TYPE
(a)
(b)
(c)
(d)
(e)
(f)
Select this checkbox if you need to add additional description of spirits or denatured spirits and containers.
11. DESCRIPTION OF WINES AND CONTAINERS
CONTAINERS
PERCENT
BOTTLES
SIZE OF
WINE
TAX
KIND
4/
ALCOHOL
NO. AND TYPE
SERIAL NUMBER
PER CASE
BOTTLES
GALLONS
LIABILITY
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Select this checkbox if you need to add additional description of wine and containers.
Under the penalties of perjury, I declare that the spirits, denatured spirits, or wines described above are truly intended to (or have been) withdrawn for the purpose
indicated, in the manner prescribed in regulations, and will not be (have not been) shipped for the purpose of evading or delaying payment of any revenue tax thereon.
5/
12. DATE
13. PRINCIPAL
13a. SIGNATURE
13b. TITLE
FOR TTB USE ONLY PART II - APPROVAL OF APPLICATION
14. DATE
15. SIGNATURE AND TITLE OF APPROVING OFFICER
1/ State whether (a) vessel or aircraft operated by the United Slates; (b) vessel or aircraft engaged in foreign trade, or in trade between the United States and any of its possessions, or between
Hawaii or Alaska and any other part of the United states; (c) vessel of the United States engaged in trade between Atlantic and Pacific ports of the United Slates; (d) vessel of war of any foreign
nation; or (e) vessel employed in: (1) the fisheries; or (2) the whaling business. Show name of vessel, country of registry, and ports of call, or, if a whaling vessel, location of operations. If aircraft,
show also name of airline and country of registry of aircraft.
2/ Also enter formula number for special denatured spirits.
3/ Enter quantity of spirits in proof gallons or quantity of denatured spirits in wine gallons and check applicable box.
4/ In Items 11(d) and 22 show filling date when use of that date is authorized instead of serial numbers on cases. Item 11(d) need not be completed when prior approval of application is required.
5/ Show principal on bond under which withdrawal is made. Do not complete this section if the exporter is exempt from bond requirements under 27 CFR 28.51(b). An exporter is exempt only if all of the following are true: the distilled spirits or wine to be
exported is for nonindustrial use; the exporter is a taxpayer (as defined in § 28.51(c)) who reasonably expects to be liable for not more than $50,000 in taxes described in 26 U.S.C. 5061(d)(4) during the current calendar year; the exporter was liable for not
more than $50,000 in such taxes in the preceding calendar year; and the exporter pays such taxes on a deferred basis using a semimonthly, quarterly, or annual return period as described in 26 U.S.C. 5061(d).
TTB F 5100.11 (11/2016)
Page 1 of 3
PART III - PROPRIETOR’S REPORT OF INSPECTION AND TAX LIABILITY
The spirits described on Page 1 were inspected, as reported below, and have been prepared for withdrawal as required by regulations.
16. WITHDRAWAL IS FROM:
17.
PACKAGE GAUGE
RECORD ATTACHED
PRODUCTION ACCOUNT
STORAGE ACCOUNT
PROCESSING ACCOUNT
18.
CONTAINERS (Leave blank if no change)
TAXABLE
TAX
QUANTITY
NUMBER
GALLONS
IDENTIFICATION
LIABILITY
DETERMINED BY
(a)
(b)
(c)
(d)
GAUGE FOR
INSPECTION
WITHDRAWAL
REGAUGE AFTER REDUCTION IN
PROOF
19. DATE
20. PROPRIETOR OF DISTILLED SPIRITS PLANT
20a. BY (Signature and title)
PART IV - CERTIFICATE OF REMOVAL OF WINE FROM BONDED WINE CELLAR (Complete only if approval of application is required)
I certify that the wines described above
21. REMOVED FROM BONDED WINE CELLAR
22. SERIAL NUMBERS OF CONTAINERS
4/
were removed for the purpose stated in
NO.
Item 6.
23. DATE REMOVED 24. PROPRIETOR OF BONDED WINE CELLAR
24a. BY (Signature and title)
PART V - CUSTOMS OFFICER’S REPORT OF INSPECTION AND LADING, SHIPMENT, OR RECEIPT
25. NOT INSPECTED (Give reason for not inspecting)
25a. INSPECTED AND FOUND TO BE AS DESCRIBED
EXCEPT AS NOTED IN ITEM 31
26. RECORDS OF DELIVERING AND EXPORTING CARRIERS SHOW THAT CONTAINERS OF SIMILAR DESCRIPTION
27. LADEN ON (Date)
WERE RECEIVED BY THE EXPORTING CARRIER FOR DELIVERY TO THE FOREIGN PORT NAMED IN ITEM 6
AND WERE LADEN ON BOARD THE EXPORTING CONVEYANCE AS REPORTED IN THIS FORM.
ON BOARD: VESSEL (Name)
AIRCRAFT (Name, symbols, number)
28. LADEN FOR
EXPORT
USE AS
RAILROAD CAR (Number)
TRUCK (State license)
SUPPLIES
29. RECEIVED IN
(No. or Location)
30. SHIPPED TO (Frontier port)
SERIAL NUMBER ON SEAL USED
CMBW
FTZ
CBW
31. DISCREPANCY OR SHORTAGE
32. DATE
33. PORT
34. SIGNATURE AND TITLE OF CUSTOMS OFFICER/WAREHOUSE PROPRIETOR
PART VI - CUSTOMS OFFICER’S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
35. FRONTIER PORT
36. DATE RECEIVED 37. INSPECTION DISCLOSED
NO EVIDENCE OF TAMPERING
SEALS INTACT
SEALS BROKEN (See item 38)
38. DETAILS OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
39. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 28, BEARING THE SHIPMENT DESCRIBED
Foreign Port
IN PART I, WITH EXCEPTIONS AS NOTED IN ITEMS 31 AND 38 CLEARED FROM THIS PORT FOR
THE PORT OF
40. DATE
41. SIGNATURE AND TITLE OF CUSTOMS OFFICER
PART VII - CERTIFICATE OF CLEARANCE OR USE
42. THE EXPORTING CONVEYANCE BEARING THE SHIPMENT DESCRIBED IN PART I, WITH EXCEPTIONS AS NOTED ABOVE --
CLEARED FROM PORT OF
ON (Date)
BOUND FOR (Foreign port)
43. THE SPIRITS OR WINES DESCRIBED HAVE BEEN USED AS SUPPLIES ON THE AIRCRAFT OR FISHING VESSEL IDENTIFIED ABOVE AND
THE REQUIRED EVIDENCE OF THEIR USE HAS BEEN RECEIVED.
44. DATE
45. SIGNATURE OF DISTRICT DIRECTOR OF CUSTOMS
PART VIII - CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
The distilled spirits or wines, described in Part I, with exceptions as noted in Item 47, were received for export to the Armed Forces of the United States.
The spirits or wines will not be shipped f or consumption or use to any place subject to application of the Internal Revenue laws of the United States.
46. DATE
47. DISCREPANCY
48. SIGNATURE
49. RANK
50. TITLE
Page 2 of 3
TTB F 5100.11 (11/2016)
(Continuation)
OMB No. 1513-0037
DEPARTMENT OF THE TREASURY
1. SERIAL NO. (Begin with
“1” each Jan. 1)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
WITHDRAWAL OF SPIRITS, SPECIALLY DENATURED SPIRITS, OR WINES FOR EXPORTATION
.
Please read Instructions after Page 3 before completing this form.
PART I - APPLICATION OR NOTICE
2. APPLICATION IS MADE TO
3. NOTICE GIVEN OF
WITHDRAW SPIRITS OR WINES
WITHDRAWAL OF SPECIALLY
WITHDRAWAL OF SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
DENATURED SPIRITS FREE OF TAX
WITHOUT PAYMENT OF TAX
4. WITHDRAWAL FROM
OPERATED BY
5. ADDRESS OF DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
BW. ______________________
550 MAIN ST, STE 8002
DSP. _______________________
CINCINNATI, OH 45202-5215
10. DESCRIPTION OF SPIRITS OR DENATURED SPIRITS AND CONTAINERS (Columns a, d, e, and f only are required for denatured spirits)
3/
PRODUCED BY
FILLED BY
CONTAINERS
PG
2 /
KIND
NAME
DSP NO.
IDENTIFICATION
WG
NO. AND TYPE
(a)
(b)
(c)
(d)
(e)
(f)
11. DESCRIPTION OF WINES AND CONTAINERS
CONTAINERS
PERCENT
BOTTLES
SIZE OF
WINE
TAX
KIND
4/
ALCOHOL
NO. AND TYPE
SERIAL NUMBER
PER CASE
BOTTLES
GALLONS
LIABILITY
(a)
(b)
(d)
(e)
(f)
(g)
(h)
(c)
Under the penalties of perjury, I declare that the spirits, denatured spirits, or wines described above are truly intended to (or have been) withdrawn for the purpose
indicated, in the manner prescribed in regulations, and will not be (have not been) shipped for the purpose of evading or delaying payment of any revenue tax
thereon.
5/
12. DATE
13. PRINCIPAL
13a. SIGNATURE
13b. TITLE
TTB F 5100.11 (11/2016)
Page 3 of 3
INSTRUCTIONS
(Read Prior to Completing Form)
1. EXPORTER.
b. USE ON AIRCRAFT OR FISHING VESSELS. After inspection of
lading, the Customs officer must complete Part V on both copies
a. GENERAL. Prepare Part I of this form in quadruplicate. Prepare a
and forward them (with any attachments) to the District Director of
fifth copy, marked “consignee’s copy” when distilled spirits or wines
Customs. On receipt of the required certificate of use (for aircraft)
are for use on aircraft.
or Customs Form 5125 (for fishing vessels), the District Director of
Customs must complete Part VII, forward the original (with any
b. APPLICATION. As provided in 27 CFR Part 28, this form must be
attachments) to the Director, National Revenue Center, TTB, at the
prepared as an application if the exporter is not the proprietor of
address shown in Item 5, and retain the copy for his/her files.
the bonded premises from which the spirits or wines are to be
withdrawn. Before withdrawal is made, application for withdrawal of
c. LADING AT INTERIOR PORT AND EXPORTATION THROUGH
spirits or wines must be approved by the Director, National Revenue
FRONTIER PORT. On completion of lading, the Customs office
Center, Alcohol and Tobacco Tax and Trade Bureau.
must affix the seals and complete Part V on both copies and
forward them (with any attachments) to the District Director of
c. NOTICE. If the exporter is the proprietor of the bonded premises
Customs at the interior port for forwarding to the Customs officer at
from which the spirits (including denatured spirits) or wines are to
the frontier port: PROVIDED, that where the shipment is by truck
be withdrawn, the form must be prepared as a notice.
and where instructions from the District Director of Customs so
provide, the copies may be forwarded via the truck driver to the
2. SHIPMENTS - DISPOSITION OF FORMS.
Customs officer at the frontier port. When satisfied that the
shipment has been exported, that officer must complete Part VI on
a. DISTILLED SPIRITS OR DENATURED SPIRITS.
The proprietor
both copies and return them (with any attachments) to the District
of the distilled spirits plants must enter the results of any required
Director of Customs at the interior port. The District Director must
inspection and regauge in Part III and distribute the form, as
then execute Part VII on both copies , forward the original (with any
follows:
attachments) to the Director, National Revenue Center, TTB, at the
address shown in Item 5, and retain the copy for his/her files.
(1) forward the original and one copy (with any attachments) to the
official designated in Item 7,
d. RECEIPT IN MANUFACTURING BONDED WAREHOUSE.
On
(2) forward a copy (with any attachments) to the Director, National
receipt of the shipment, the warehouse proprietor must make a
Revenue Center, TTB, and
report of his/her gauge on Customs Form 6001, complete Part V and
(3) retain a copy for his/her files.
attach a copy of the Form 6001 to each copy of the form, forward
the original (with any attachments) to the Director, National Revenue
In the case of shipment by tank truck, the forms must be placed in
Center, TTB, at the address shown in Item 5, and retain the copy for
a properly addressed sealed envelope and handed to the driver of
his/her files.
the truck for delivery to the officer to whom the shipment is
consigned.
e. RECEIPT IN FOREIGN -TRADE ZONE. On receipt of the
shipment, the Customs officer in charge must, if necessary, make a
b. WINES. The proprietor must complete Part IV, if applicable, and
report of gauge on Customs Form 6001, complete Part V and
distribute the form, as follows:
attach a copy of the Form 6001 to each copy of the form, forward
the original (with any attachments) to the Director, National Revenue
(1) forward the original and one copy to the official designated in
Center, TTB, at the address shown in Item 5, and retain the copy for
Item 7,
his/her files.
(2) forward a copy to the Director, National Revenue Center, TTB,
and
f. RECEIPT IN CUSTOMS BONDED WAREHOUSE.
On receipt of
(3) retain the copy for his/her files.
the shipment, the warehouse proprietor must complete Part V, for-
ward the original (with any attachments) to the Director, National
c. CONSIGNEE’S COPY. If a consignee’s copy has been prepared
Revenue Center, TTB, at the address shown in Item 5, and retain
as required by Instruction 1a above, the proprietor must forward it
the copy for his/her files.
to the airline company official at the airport.
4. ACTION BY ARMED FORCES OFFICER.
On receipt of the
3. ACTION BY WAREHOUSE PROPRIETOR OR CUSTOMS OFFICIAL.
shipment, the officer to whom consigned (or other authorized supply
officer) must complete Part VIII on both copies of the form, forward the
a. SHIPMENTS FOR DIRECT EXPORTATION OR FOR USE ON
original (with any attachments) to the Director, National Revenue
VESSELS OTHER THAN FISHING VESSELS.
After inspection of
Center, TTB, at the address shown in Item 5, and retain the copy for
lading, the Customs officer must complete Part V on both copies
his/her files.
and forward them (with any attachments) to the District Director of
Customs. On clearance of the conveyance, the District Director
must complete Part VII, forward the original (with any attachments)
to the Director, National Revenue Center, TTB at the address shown
in Item 5, and retain the copy for his/her files.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to ensure that spirits withdrawn from bond
without payment of tax are used only for the pur pose authorized by law. This collection is also necessary to ensure that the proprietor’s bond coverage for
the type of withdrawals is not exceeded. The information requested is mandatory by statute (26 U .S.C. 5066, 5214, and 5362).
The estimated average burden associated with this collection of information is 30 minutes 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 5100.11 (11/2016)
Page of 4