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pdfDEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
OMB No. 1513-0125 (06/30/2010)
TYPE OF BOND PER 26 U.S.C. 5173 and 5181
(Check applicable box 1, 2, 3, OR 4)
1. OPERATIONS (Select (a), (b), or (c) below)
DISTILLED SPIRITS BOND
(a) ONE PLANT BOND
(See instructions on Page 4)
(b) ADJACENT WINE CELLAR BOND
PRINCIPAL/OBLIGOR (See instructions 2, 3, and 4.)
(c) AREA BOND
2. WITHDRAWAL BOND
3. UNIT BOND
ADDRESS OF BUSINESS OFFICE (Number, Street, City, State, ZIP Code)
4. ALCOHOL FUEL PRODUCER BOND
BOND KIND (Select only one)
ORIGINAL
STRENGTHENING
SUPERSEDING
AMOUNT OF BOND
EIN:
EFFECTIVE DATE
BOND CATEGORY (Select only one category (i.e. ‘Surety,’ ‘Cash,’ or ‘Treasury Note/Bond’) and complete corresponding items to right
of selection)
SURETY NAME
SURETY:
BOND NUMBER
CASH
CHECK NUMBER(S) (i.e. personal check, cashier’s check, money order, etc.)
NOTE/BOND CUSIP NO.
TREASURY
NOTE/BOND**
NOTE/BOND MATURITY DATE
NOTE/BOND INTEREST RATE
%
NOTE/BOND ISSUE DATE
**This bond is secured by the Treasury collateral (T-Note) described above or by a T-Note resulting from reinvestment of the full
proceeds from the T-Note described above. T-Note collateral reinvestment will automatically occur upon maturity unless the obligor
notifies TTB in writing at least 45 days prior to the maturity date that the T-Note proceeds should not be reinvested and the obligor
requests this bond be terminated.
BOND EXECUTION
Witness our hands and seals this
day of
, 20
. Signed, sealed and delivered in the presence of --
PRINCIPAL/OBLIGOR NAME
BY:
SURETY NAME
PRINCIPAL/OBLIGOR REPRESENTATIVE’S SIGNATURE
PRINCIPAL/OBLIGOR REPRESENTATIVE’S PRINTED NAME/TITLE
SURETY REPRESENTATIVE SIGNATURE
SIGNATURE, WITNESS 1 (If no seal)
SURETY REPRESENTATIVE PRINTED NAME & TITLE
SIGNATURE, WITNESS 2 (If no seal)
CORPORATIONS/PARTNERSHIPS, OR LLC SEALS
State in which Principal/Obligor organized:
Impress
Surety
Seal
Impress Principal/Obligor’s corporate or
LLC seal or select the checkbox below
The corporation/LLC has no seal.
TTB F 5110.56 (12/2007)
PAGE 1 OF 4
Principal/
Obligor
Seal
PRINCIPAL/OBLIGOR
DATE
NAME AND PREMISES ADDRESS
REGISTRY
NUMBER
OPERATIONS COVERAGE
(State activities at each
premises and the amount of
coverage for such activities.)
AMOUNT OF OPERATIONS
COVERAGE
WITHDRAWAL COVERAGE
(State amount allocated to
each premises (distilled spirits
plant(s) only) and total
amount.)
WITHDRAWAL COVERAGE
TOTAL
Alterations made on this bond before and after execution were made with the consent of the Principal/Obligor
and Surety
(if applicable). (Initial the appropriate blank. See Instruction 6)
DIRECTOR, NATIONAL REVENUE CENTER APPROVAL
ON BEHALF OF THE UNITED STATES, I APPROVE THE FOREGOING BOND WHICH HAS BEEN EXECUTED IN DUE
FORM IN COMPLIANCE WITH THE APPLICABLE LAWS, REGULATIONS AND INSTRUCTIONS.
SIGNATURE OF AUTHORIZED OFFICIAL, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Director, National Revenue Center
TTB F 5110.56 (12/2007)
PAGE 2 OF 4
DATE APPROVED
PRINCIPAL/OBLIGOR
DATE
TERMS OF THIS BOND
The Type of Activity (distiller, warehouseman, processor, adjacent
wine cellar, or alcohol fuel producer) and the premises covered by
this bond are specified on page 2 of the bond and, if necessary,
on an additional sheet appropriately identified and attached to this
bond.
PURPOSE: The above principal has filed an application for
registration of the distilled spirits plant(s) specified.
DEFINITIONS. Definitions pertinent to this bond:
PRINCIPAL. The proprietor of the distilled spirits plant
premises covered by a surety bond
OBLIGOR. The proprietor of the distilled spirits plant premises
covered by a collateral bond
COLLATERAL BOND. A bond secured by tangible assets
such as cash or United States Treasury Bond or Note
CONDITIONS: The above principal/obligor and surety (sureties)
are bound independently and jointly for the payment to the United
States in the above amounts of lawful money of the United States.
In this bond, the terms principal or surety include the heirs,
executors, administrators, successors, and assigns of the
principal/obligor or surety.
If this bond covers only withdrawals, the following clauses 4, 5,
6, and 7 do not apply.
If this bond covers only operations, the following clause 3 does
not apply.
If this bond covers only alcohol fuel production operations, the
following clauses 3 and 7 do not apply.
THE PRINCIPAL/OBLIGOR MUST:
(1) Comply with all requirements of law and regulations, now or
hereafter in force, relating to the activities covered by this
bond;
(2) Pay all penalties incurred and fines imposed for violations of
law or regulations, now or hereafter in force, relating to the
activities covered by this bond;
(3) Pay all taxes (including any penalties and interest in respect of
failure to file a timely return, or to pay such tax when due) on
distilled spirits withdrawn tax- determined from bonded
premises imposed under 26 U.S.C. Chapter 51;
(4) Pay all taxes (including any penalties and interest) imposed
under 26 U.S.C. Chapter 51, including taxes on all unexplained
shortages of bottled distilled spirits;
(5) Comply with all requirements of law and regulations, now or
hereafter in force, pertaining to all distilled spirits (including
denatured spirits, fuel alcohol, and article) removed from or
returned to the bonded premises free of tax;
(6) With respect to distilled spirits withdrawn from the bonded
premises without payment of tax as authorized by law, (a)
comply with all requirements of law and regulations, now or
hereafter in force relating thereto, and (b) as to said distilled
spirits or any part thereof withdrawn, for example, for
exportation, or for use on vessels or aircraft, or for transfer to a
foreign-trade zone, or for transfer to a Customs bonded
warehouse, or for research, development, or testing, and not
so exported, used or transferred, or otherwise lawfully
PRINCIPAL/OBLIGOR
INITIAL(S)
disposed of or accounted for, pay the tax imposed thereon by
law, now or hereafter in force, together with penalties and
interest; and
(7) As the proprietor of a bonded wine cellar, pay all taxes imposed
by law, now or hereafter in force, (including any penalties and
interest) for which he/she may become liable with respect to
operation of the said bonded wine cellar, and all distilled spirits
and wine now or hereafter in transit thereto or received thereat,
and on all distilled spirits and wine removed therefrom,
including wine withdrawn without payment of tax, on notice by
principal, for exportation, or use on vessels or aircraft, or
transfer to a Customs bonded warehouse, or transferred to a
foreign-trade zone, and not so exported, used, or transferred, or
otherwise lawfully disposed of or accounted for; provided, that
up to $500 of the operations coverage of a $1,000 bond ($1,000
operations coverage of a bond of $2,000 or more) may be
applied to taxes that have been determined, but not paid on
wine removed from premises..
CHANGE OF PREMISES: All stipulations, covenants, and
agreements of this bond will extend to and apply to any change in
the business address of the premises, the extension or curtailment
of such premises, including the buildings thereon, or any
equipment or any other change which requires the principal/obligor
to file a new or amended registration, application, or notice, except
where the change constitutes a change in the proprietorship of the
business, or in the location of the premises. Further, this bond will
continue in effect whenever operations of the plant are resumed
from time to time following suspension of operations by an
alternate proprietor.
TREASURY COLLATERAL BONDS: If this bond is filed as a
collateral bond secured by a Treasury Note or Bond in an
approved Department of Treasury holding account, this bond is
secured by the Treasury collateral identified on the face of the
bond and any Treasury collateral resulting from roll over of the
previous Treasury collateral. The Treasury collateral identified in
this bond will automatically roll over upon maturity unless the
obligor notifies the National Revenue Center at least 45 days prior
to maturity.
DEFAULT: If the principal/obligor of a surety bond fails to fulfill any
of the terms or conditions of this bond, the United States may seek
compensation and pursue its remedies independently from either
the principal/obligor or surety, or jointly from both. The surety
hereby waives any right of privilege it may have of requiring, upon
notice, or otherwise, that the United States will first commence
action, intervene in any action of any nature whatsoever already
commenced or otherwise exhaust its remedies against the
principal/obligor.
If the obligor of a collateral bond fails to fulfill any of the terms or
conditions of this bond, the United States may apply any
outstanding tax liability (including any penalties or interest) against
the collateral deposited.
EFFECTIVE DATE: If accepted by the United States, the bond will
be effective according to its terms on and after the effective date
without notice to the obligors. Provided, that if no effective date is
inserted in the space provided, the date of execution shown on
page 1 of the bond will be the effective date of the bond.
ACKNOWLEDGE TERMS BELOW:
DATE
SURETY
PAGE 3 OF 4
INITIAL(S)
DATE
TTB F 5110.56 (12/2007)
INSTRUCTIONS
1.
2.
File duplicate original bonds with the Director, National
Revenue Center, Alcohol and Tobacco Tax and Trade
Bureau, 550 Main St., Ste 8002, Cincinnati, OH 452025215
4.
The signature for the surety will be attested under
corporate seal. The signature for the principal/obligor, if a
corporation or LLC, also will be attested by seal if the
corporation or LLC has a seal. If the corporation or LLC
has no seal, that fact will be noted. Each signature will be
made in the presence of two persons (except where
corporate or LLC seals are affixed), who must sign their
names as witnesses.
5.
A bond may be given with (a) corporate surety authorized to
act as surety by the Secretary of the Treasury, (b) by the
deposit of Government obligations. A Government obligation
is defined in 31 U.S.C. 9301 as “a public debt obligation of
the United States Government and an obligation whose
principal and interest is unconditionally guaranteed by the
Government.” Such obligations include Treasury Notes or
Treasury Bonds, or cash in the form of a check or similar
legal tender made payable to the Alcohol and Tobacco Tax
and Trade Bureau for deposit in an approved Department of
the Treasury holding account.
The name, including the full given name, of each party to
the bond will be given in the heading, and each party must
sign the bond with such party’s signature, or the bond may
be executed in the party’s name by an empowered
attorney-in-fact.
a.
b.
c.
3.
Tax and Trade Bureau, in which event a statement to the
effect must be attached to the bond.
In the case of a partnership, the partnership name,
followed by the names of all its partners will be given
in the heading. In executing the bond, the partnership
name will be typed or written followed by the word
“by” and the signatures of all partners, or the
signature of any partner authorized to sign the bond
for the firm, or the signature of an empowered
attorney-in fact. The name of the state in which the
partnership is organized will be given in the space
provided above the signature lines.
If the principal/obligor is an LLC, the LLC name will be
given in the heading. In executing the bond the LLC
name will be typed or written followed by the word
“by” and the signature and title of the managing
member, any member authorized to sign the bond for
the LLC, or an empowered attorney-in-fact. The name
of the state in which the LLC is organized will be
given in the space provided above the signature lines.
If the principal/obligor is a corporation, the heading
will give the corporate name and the address of the
principal business office. The name of the state in
which the corporation is organized will be in the space
provided above the signature lines. The bond will be
executed in the corporate name, immediately followed
by the signature and title of the person authorized to
act for the corporation.
If the bond is signed by an attorney-in-fact for the
principal/obligor, or by one of the members of a
partnership, LLC, or association, or by an officer or other
person for a corporation, there will be filed with the bond
an authenticated copy of the power of attorney, or
resolution of the board of directors, or an excerpt of the
bylaws, or other documents, authorizing the person
signing the bond to execute it by the principal/obligor,
unless an authorization has been previously filed with the
Director, National Revenue Center, Alcohol and Tobacco
Contact the National Revenue Center toll free at 1-877882-3277 regarding allowable types of collateral.
6.
If any alteration or erasure is made in the bond before or
after its execution, complete the alteration statement on
page 2 and make sure that the Principal and Surety or
Sureties OR Obligor initial the statement.
7.
The penal sum named in the bond will be in accordance with
27 CFR Part 19.
8.
If the bond is approved, a copy will be returned to the
principal/obligor.
9.
All correspondence about the filing of this form or any
subsequent action, including termination, affecting this bond
should be directed to Director, National Revenue Center,
Alcohol and Tobacco Tax and Trade Bureau, 550 Main St,
Ste 8002, Cincinnati, OH 45202-5215 or 1-877-882-3277
(toll free).
10. To ensure that all parts of each bond are properly identified,
add the Principal/Obligor name and date at the top of pages
2 and 3. The principal/obligor and the surety must also
initial and date page 3 in the space provided to acknowledge
that they have read and are familiar with the terms of the
bond
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used by proprietors of Distilled
Spirits Plants and Alcohol Fuel Plants to file bond coverage with TTB. The bond may be secured through a surety company or it may be
secured with collateral (cash, Treasury Bonds, or Notes). The bond protects the revenue assigned to distilled spirits on which excise tax
has not been paid. The information is mandatory by statute (26 U.S.C. 5173 and 5181).
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 the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau,
Washington, DC 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.
PAGE 4 OF 4
TTB F 5110.56 (12/2007)
File Type | application/pdf |
File Title | OMB No |
Author | TTB |
File Modified | 2007-12-04 |
File Created | 2007-10-17 |