Old Version of TTB F 5110.75

Form Approved: OMB No. 1513-0052 (10/31/06)
1. PERMIT NUMBER

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

ALCOHOL FUEL PLANT REPORT

GENERAL INSTRUCTIONS
1. Each proprietor of an alcohol fuel plant shall file this annual report of plant
operations. A report is due even if no operations were conducted during
the period.
2. Prepare in duplicate. Send the original to the Director, National Revenue Center,
Alcohol and Tobacco Tax and Trade Bureau, 550 Main St., Ste 8002,
Cincinnati, OH 45202-5215. Keep the copy with your AFP records.

4. Report is due by January 30th following the end of the calendar year.
5. Report spirits in proof gallons and alcohol fuel in wine gallons. Round to
the nearest whole number.
6. Small and medium plants complete Part I and II. Large plants complete
Parts I and III.

3. Proprietors will prepare and file a report once a year to cover ail operations
for the calendar year.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with Section 3507, Public Law 96-511, December 11, 1980. This information collection is used to monitor and audit the operations
of alcohol fuel plants and to collect statistics regarding the production and use of alcohol for fuel use. The information required is mandatory by statute (26
U.S.C. 5207).
The estimated average burden associated with this collection of information is 1 hour 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 Reports Management Officer,
Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220, and the Office of Management and Budget, Paperwork
Reduction Project (1513-0051), Washington, D.C. 20503.
PART - I
1. REPORT FOR CALENDAR YEAR
2. TYPE OF PLANT

_____ SMALL

3. NAME OF PROPRIETOR (If partnership, include name of each partner)

_____ MEDIUM

_____ LARGE

4. LOCATION (If no street show rural route)

PART-II
FOR SMALL AND MEDIUM PLANTS ONLY
SPIRITS TRANSACTIONS

PROOF GALLONS

PROOF GALLONS

WINE GALLONS

WINE GALLONS

1. PRODUCED
2. RECEIVED
3. USED ON PREMISES FOR FUEL (Do not include fuel alcohol)
4. USED IN MAKING FUEL ALCOHOL
5. DESTROYED
6. TRANSFERRED
FUEL ALCOHOL TRANSACTIONS
7. PRODUCED (Rendered Unfit)
8. USED ON PREMISES FOR FUEL
9. TRANSFERRED
Under penalties of perjury I declare that I have examined this report, and to the best of my knowledge and belief, it is a true and complete report of
operations.
10.

SIGNATURE

TTB F 5110.75 (5/2005)

11.

DATE

PART - III
FOR LARGE PLANTS ONLY
Report the loss (line 11) or the gain (line 4) of spirits found by taking the required physical inventory for the reporting period. Report any losses by theft
separately (line 10). Report and identify on line 5 the quantity of any imported spirits received from customs custody.
SPIRITS TRANSACTIONS
PROOF GALLONS
PROOF GALLONS
1. ON HAND BEGINNING OF REPORTING PERIOD
2. PRODUCED BY DISTILLING
3. RECEIVED FROM OTHER PLANTS
4. INVENTORY GAIN
5.
6. TOTAL - (Lines 1 through 5)
7. USED IN MAKING FUEL ALCOHOL
8, USED ON PLANT PREMISES FOR FUEL

(Do not include fuel alcohol)

9. USED AS DISTILLING MATERIAL OR FOR REDISTILLING
10. LOST BY THEFT
11. INVENTORY LOSS
12. TRANSFERRED TO OTHER PLANTS
13. DESTROYED
14.
15. TOTAL, - . (Lines.7 through 14)
16. ON HAND END OF PERIOD

(Subtract line 15 from line 6)

FUEL ALCOHOL TRANSACTIONS

WINE GALLONS

17. MANUFACTURED
18. DISTRIBUTED OR SOLD FOR FUEL PURPOSES
19. USED ON PLANT PREMISES FOR FUEL PURPOSES
20. DESTROYED
21. ALL OTHER DISPOSITIONS
22. REMARKS

Under penalties of perjury I declare that I have examined this report, and to the best of my knowledge and belief, it is a true and complete report of
operations.
23. SIGNATURE
24. DATE
TTB F 5110.75 (5/2005)