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pdfOMB No. 1513-0000 (00/00/2000)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
STATEMENT OF MANUFACTURER’S VENDEE (USE IN FURTHER MANUFACTURE)
(To support tax-free sales of taxable articles to a purchaser for resale to a second purchaser for use in further
manufacture (section 4221(a)(1) of the Internal Revenue Code).)
, 20
.
(Date)
The undersigned, or the
of which
(Name of manufacturer's vendee if other than undersigned)
I am
holds certificate of registry No.
,
(Title)
issued by the TTB Director, National Revenue Center at
.
(city and State)
The article or articles specified below or on the reverse side hereof were purchased tax-free by me or by
on
(Name of manufacturer’s vendee if other than undersigned)
and were thereafter resold to a purchaser who holds certificate of registry No.
TTB Director, National Revenue Center at
,
(Date)
, issued by the
, for use by it as material in the
(city and State)
manufacture or production of, or as a component part or parts of, an article or articles taxable under Chapter 32 of the
Internal Revenue Code.
The undersigned, or
,
(Name of manufacturer's vendee if other than undersigned)
has in my/its possession proof of tax-free resale of such article or articles in the form of related purchase orders and sales
invoices, and proof of tax-free resale will be retained by me or
,
(Name of manufacturer's vendee if other than undersigned)
for at least 3 years from the date of this statement, and will be made readily available for inspection by TTB officers during
such 3-year period.
I have not previously executed a statement in respect of such certificate of resale, and I understand that the fraudulent
use of this statement may subject me and all parties making such fraudulent use of this statement to all applicable
criminal penalties under the Internal Revenue Code.
SIGNATURE
PRINTED NAME
ADDRESS
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. In some cases, persons who sell firearms or ammunition tax-free use specific
statements to support the tax-free sales. In addition, a specific statement from the ultimate vendor to support claims for certain tax refunds or credits is
required. This form contains all required information for a properly executed statement. This is being provided to promote uniformity among excise taxpayers
and eliminate the need for taxpayers to design their own statements. The information requested is required by Title 27, Code of Federal Regulations, Part 53.
We estimate the average burden associated with this collection of information is 45 minutes per respondent or recordkeeper, depending on your individual
circumstances. Address your comments concerning the accuracy of this burden estimate and suggestions to reduce this burden to: Reports Management
Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.
TTB may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a current, valid OMB control number.
TTB F 5600.37 (08/2007)
File Type | application/pdf |
File Title | DEPARTMENT OF THE TREASURY |
Author | TTB |
File Modified | 2007-08-21 |
File Created | 2007-08-21 |