Form TTB F 5630.5 TTB F 5630.5 Special Tax Registration and Return

OMB NO. 1513-011 2 (03/31/2009)

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

SPECIAL-( TAX REGISTRATION AND RETURN
(Please Read Instructions Carefully Before Completing This Form)

SECTION I - TAXPAYER IDENTIFYING INFORMATION
1. EMPLOYER IDENTIFICATION NUMBER ( Required. See 2. BUSINESS TELEPHONE NUMBER
instruction s.)
s
(
)
3. NAME (Last, First, Middle)
OR
OWNER NAME (Name of Corporation, Partnership or LLC) ,

FOR TTB USE ONLY
T
FF

4. TRADE NAME

FP
5. MAILING ADDRESS (Street address or P.O. box number)
6. CITY

I

STATE

T

ZIP CODE

9. TAX PERIOD COVERING
(only one tax period per form)

) ACTUAL LOCATION

(IF DIFFERENT THAN ABOVE)
7. PHYSICAL ADDRESS OF PRINCIPAL PLACE OF BUSINESS (Show street address)
8. CITY

STATE

FROM: _______________
(mm/dd/yyyy)
ZIP CODE
TO: June 30, ________
(yyyy)

SECTION II - TAX COMPUTATION
TAX CLASS DESCRIPTION (FOR ITEMS MARKED*, SEE INSTRUCTIONS)
MONTHLY
(a)
(b)
RETAIL
DEALER

ANNUAL LOCATIONS TAX DUE
(c)
(d)
(e)

11
12

Liquors (Distilled spirits, wine , or beer)
Beer only
Liquors (Distilled spirits, wine , or beer) - at large

15
16

Beer only - at large
WHOLESALE
DEALER

Distilled spirits, wine , or beer
Beer only

BREWER

Regular rate
REDUCED rate*

31
32
41

NONBEVERAGE DRAWBACK CLAIMANT
INDUSTRIAL
User of specially denatured alcohol
ALCOHOL
Dealer in specially denatured alcohol
User of tax-free alcohol
ALCOHOL
Proprietor of alcohol fuel plant
PRODUCERS
Proprietor of alcohol fuel plant - REDUCED*

43*
51
1
$20.83 /3
1/
$20.83 3
1
$20.83 /3

250

250

250

250

250

250

$0.00
$0.00
$0.00

86*
82
87*
83
88*

Proprietor of bonded wine warehouse
Proprietor of bonded wine warehouse - REDUCED*
Proprietor of taxpaid wine bottling house

Manufacturer of tobacco products - REDUCED*
Manufacturer of cigarette papers and tubes
Manufacturer of cigarette papers and tubes - REDUCED*
Proprietor of export warehouse
Proprietor of export warehouse - REDUCED*

56
57
59*
81

Proprietor of bonded wine cellar - REDUCED*

Proprietor of taxpaid wine bottling house - REDUCED*
Manufacturer of tobacco products

55

58

Proprietor of distilled spirits plant
Proprietor of distilled spirits plant - REDUCED*
Proprietor of bonded wine cellar

TOBACCO
PRODUCTS

CODE
(f)

84
1
$83.33 /3
2
$41.66 /3
1
$83.33 /3
2
$41.66 /3

$83.33 /3
2
$41.66 /3
1

1000

500

1000

500

1000

500

$0.00
$0.00
$0.00
$0.00
$0.00

1000
500
1000
500
1000

$0.00

500

IF REQUIRED TO REGISTER AND PAY, MAKE CHECK OR MONEY ORDER PAYABLE TO "ALCOHOL
AND TOBACCO TAX AND TRADE BUREAU,"WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON
THE CHECK AND SEND IT WITH THE RETURN TO TTB, P.O. BOX 371962, PITTSBURGH, PA 15250-7962.

89*
91
95*
92
96*
93
97*

TOTAL TAX DUE

$ 0.00

Under penalties of perjury, I declare that the statements in this return/registration are true and correct to the best of my knowledge and belief; that this return/registration applies only
to the specified business and location or, where the return/registration is for more than one location, it applies only to the businesses at the locations specified on the attached list.
Note: Violation of Title26, United States Code 7206, with respect to a declaration under the penalties of perjury, is punishable upon conviction by a fine of not more than $100,000
($500,000 in the case of a corporation) or imprisonment for not more than 3 years, or both, with the costs of prosecution added thereto.

SIGNATURE

TTB F 5630.5 (06/2007 )

TITLE

Page 1 of 2

DATE

INSTRUCTION SHEET
TTB FORM 5630.5, SPECIAL TAX REGISTRATION AND RETURN

GENERAL INSTRUCTIONS
If you are engaged in one or more of the alcohol or tobacco activities
listed on this form, you are required to file this registration before
beginning business, and each year that you continue to operate.
If your activities require that you also pay the annual tax ('Industrial
Alcohol' & 'Tobacco Products' categories) you may file TTB F 5630.5R
instead.
You may file one return to cover several locations or several types of
activity. However, you must submit a separate return for each tax
period. The special occupational tax period runs from July 1 through
June 30 and all registrations and payments are due annually by July 1.
As evidence of tax payment, you will be issued a Special Tax Stamp,
TTB F 5630.6A, for each location and/or business.
The special tax rates listed on this form became effective January 1,
1988.If you were engaged in an alcohol or tobacco related activity prior
to this date and did not pay special occupational tax, please contact the
TTB National Revenue Center for assistance. On October 22, 2004,
H.R. 4520, the American Job Creations Act of 2004, was signed into
law. As part of this act, the payment of Special Occupational Tax
(SOT) was suspended for certain businesses, for a 3-year period from
July 1, 2005 until June 30, 2008. These businesses are still required
to file this registration during the suspension period.

SECTION III - BUSINESS REGISTRATION
Please complete the ownership information in Section III. Supply the
information specified in Item 11 for each individual owner, partner, or
responsible person. For a corporation, partnership, or association, a
responsible person is anyone with the power to control the management policies or buying or selling practices pertaining to alcohol or
tobacco. For a corporation, association, or similar organization, it also
means any person owning 10 percent or more of the outstanding stock
in the business.
CHANGES IN OPERATIONS
If there is a change of address or location, TTB F 5630.5 must be
completed and submitted within 30 days of the change (90 days for
nonbeverage drawback claimants). Return your Special Tax Stamp,
TTBF 5630.6A, along with the completed TTB F 5630.5 to: TTB, NRC,
550 Main St, Ste 8002, Cincinnati, OH 45202-5215, and an amended
TTB F5630.6A will be issued. All taxpayers except retail dealers must
also contact the TTB National Revenue Center in order to amend their
permit or to obtain a new one. If special taxpayers do not register
these changes within the appropriate time frames, additional tax and
interest will be charged and penalties maybe incurred. For a change
in ownership or control of an activity, consult the TTB National Revenue
Center before beginning the activity.
DEFINITION

SECTION I - TAXPAYER IDENTIFYING INFORMATION
Complete Section I , Taxpayer Identifying Information, as specified on
the form. Enter the tax period covered by the return in the space
provided. Your return must contain a valid EMPLOYER IDENTIFICATION NUMBER (EIN). The EIN is a unique number for business entities issued by the Internal Revenue Service (IRS). You must have an
EIN whether you are an individual owner, partnership, corporation,
LLC, or a Government agency. If you do not have an EIN, contact
the Internal Revenue Service immediately to obtain one. While TTB
may assign a temporary identification number (beginning with XX) to
allow initial processing of a return which lacks an EIN, a tax stamp will
not be issued until you have submitted a valid EIN. Do not delay
submission of your return and payment past the due date pending
receipt of your EIN. If you have not received a number by the time
you file this return, write "number applied for" in the space for the
number. Submit your EIN by separate correspondence after receipt
from the IRS.
SECTION II - TAX COMPUTATION
To complete Section II, enter the number of locations in Col. (d) on the
appropriate line(s) and multiply by the tax rate, Col. (c). Insert the tax
due in Col. (e). If you begin operations after the month of July, then
you are responsible for paying a prorated amount for the portion of the
year you are in business. To compute your taxes, multiply the monthly
rate, Col. (b), by the number of months, treating parts of months as
whole months, from the date you commenced operations through June
30. (For example, if you commenced operations on March 14, you
would multiply by 4.) Compute the taxes due for each class and enter
the total amount due in the block "Total Tax Due".
INSTRUCTIONS FOR REDUCED RATE TAXPAYERS
The reduced rates for certain taxpayer classes, indicated with an
asterisk (*) in Section II, apply only to those taxpayers whose total
gross receipts for your most recent income tax year are less than
$500,000 (not just receipts relating to the activity subject to special
occupational tax). However, if you are a member of a controlled group
as defined in section 5061(e)(3) of the Internal Revenue Code, you are
not eligible for this reduced rate unless the total gross receipts for the
entire group are less than $500,000. If your business is beginning an
activity subject to special tax for the first time, you may qualify for a
reduced rate in your initial tax year if your gross receipts for the
business (or the entire control group, if a member of a control group)
were under $500,000 the previous year. If you are eligible for the
reduced rate, check item 12 in Section III and compute your tax using
the reduced rate in Section II.

A RETAIL DEALER (tax class codes 11, 12, 15, or 16) is anyone who
sells, or offers for sale, beverage alcohol products to any person other
than a dealer. Examples of retailers are package stores, restaurants,
bars, private clubs, fraternal organizations, grocery stores, or
supermarkets which sell such beverages.
A RETAIL DEALER AT LARGE is anyone who moves his/her activity
from place to place in different States, such as a circus or carnival.
A WHOLESALE DEALER (tax class codes 31 or 32) is anyone who
sells or offers for sale, beverage alcohol products to another dealer.
An IMPORTER is liable for tax as a wholesaler if he or she sells
beverage alcohol products to other dealers (wholesalers or retailers).
SIGNING RETURN
This form must be signed by the individual owner, a partner, or, in
case of a corporation, an individual authorized to sign for the
corporation.
MAILING INSTRUCTIONS
Please sign and date the return, make a check or money order payable
to ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, for the amount
in the Total Tax Due block, and MAIL THE FORM ALONG WITH THE
PAYMENT TO TTB, P.O. Box 371962, Pittsburgh, PA
15250-7962.

IF YOU NEED FURTHER ASSISTANCE
CONTACT TTB NATIONAL REVENUE CENTER

AT 1-800-937-8864 OR 513-684-2979 OR
YOU MAY SEND AN E-MAIL TO
[email protected]
ADDITIONAL INFORMATION IS ALSO AVAILABLE
AT OUR WEB SITE, WWW.TTB.GOV

SEE IMPORTANT TAXPAYER REMINDER ON THE NEXT PAGE

SECTION III - BUSINESS REGISTRATION
10. OWNERSHIP INFORMATION:
(Check One Box Only)

INDIVIDUAL OWNER

PARTNERSHIP

CORPORATION

LLC

OTHER (Specify) ____________

11. OWNERSHIP RESPONSIBILITY: (Read instruction sheet; use a separate sheet of paper if additional space is needed.)
FULL NAME
ADDRESS
POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

12.

GROSS RECEIPTS less than $500,000 (See instructions for reduced rate taxpayers on the instruction sheet below.)

13.

DATE OF CHANGE (mm, dd, yyyy)
NEW BUSINESS (NOTE: RETAILERS AND WHOLESALERS SHOW DATE ALCOHOLIC
BEVERAGE SALES BEGAN; PRODUCERS, MANUFACTURERS, AND USERS SHOW DATE
BUSINESS COMMENCED)

14.

EXISTING BUSINESS WITH CHANGE IN:
(a) NAME/TRADE NAME (Indicate)

DATE OF CHANGE (mm, dd, yyyy)

(b) ADDRESS (Indicate)

DATE OF CHANGE (mm, dd, yyyy)

(c) OWNERSHIP (Indicate)

DATE OF CHANGE (mm, dd, yyyy)
DATE OF CHANGE (mm, dd, yyyy)

(d) EMPLOYER IDENTIFICATION NUMBER
(OLD:

NEW:)

(e) BUSINESS TELEPHONE NUMBER
(
)
15.

DISCONTINUED BUSINESS

DATE BUSINESS DISCONTINUED (mm, dd, yyyy)

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information is used to ensure compliance by taxpayers of P.L. 100-647,
Technical Corrections Act of 1988, and the Internal Revenue Laws of the United States. This information collection is used to determine and collect the
right amount of tax.
The estimated average burden associated with this collection of information is .8 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.
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.

(SEE INSTRUCTION SHEET)
Page 2 of 2

TTB F 5630.5 (06/2007)

TAXPAYER REMINDER
This is an annual tax due before starting business and by July 1 each
year after that. After your initial payment of this tax, you should receive
a "renewal" registration and return each year in the mail, prior to the due
date. However, if you do not receive a renewal form, you are still liable
for the tax and should contact the TTB National Revenue Center noted
in the instructions to obtain a Special (Occupational) Tax Registration
and Return.
Your canceled check may be used as evidence of tax payment until you
receive your Special Tax Stamp from TTB.

TTB F 5630.5 (06/2007)