Form TTB F 5120.25 TTB F 5120.25 Application to Establish and Operate Wine Premises

OMB No. 1513-0009 (08/31/2006)
1.

SERIAL NUMBER

2.

DATE

3.

REGISTRY NUMBER

DEPARTMENT OF THE TREASURY
ALCOHOL TOBACCO TAX AND TRADE BUREAU (TTB)

APPLICATION TO ESTABLISH AND OPERATE WINE PREMISES
(See Instructions below)
4.

6.

TO: DIRECTOR, NATIONAL REVENUE CENTER,
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

5.

NAME AND PRINCIPAL BUSINESS ADDRESS OF APPLICANT
(Name and street, city, county, State and ZIP Code)

7.

APPLICATION IS MADE TO OPERATE (Check one only)
BONDED
WINERY

BONDED WINE
CELLAR

TAX PAID WINE
BOTTLING HOUSE

ADDRESS (If different from address in Item 6)

PHONE #
PHONE #
EIN#
8. PURPOSE FOR WHICH FILED (Such as original establishment, trade name change, alternation of premises)

9.

APPLICATION FORM AND ATTACHED DOCUMENTS
This application includes: (1) this form; (2) the papers and documents which are being submitted for the first time, and which are listed in Items 9A
and 9B; (3) the current papers and documents of the latest approved TTB F 5120.25 Serial No. _______, which are listed in Items 9A-1 and 9B-1;
and (4) the supporting organizational documents filed in connection with another establishment but incorporated in this application by reference,
and listed below in Item 9C.

9A. PAGES ATTACHED TO THIS FORM:

9A-1. PAGES FROM CURRENT APPROVED TTB F 5120.25

NUMBERS
9B. ORGANIZATIONAL DOCUMENTS ATTACHED TO THIS FORM:
(List each document)

NUMBERS
9B-1. ORGANIZATIONAL DOCUMENTS FILED WITH PRIOR
APPROVED TTB F 5120.25 (List each document)

9C. ORGANIZATIONAL DOCUMENTS FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT BUT INCORPORATED IN THIS APPLICATION BY
REFERENCE: (List each document, and show the name or plant number under which filed)

10. IF NOT APPLYING AS A BONDED WINERY, WOULD YOU AGREE TO HAVE YOUR NAME LISTED IN AN TTB PUBLICATION?
YES

NO

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS APPLICATION AND, TO THE BEST OF MY KNOWLEDGE AND
BELIEF, IT IS TRUE, CORRECT AND COMPLETE.
11. SIGNATURE
12. TITLE

FOR TTB USE ONLY
APPLICATION IS

EFFECTIVE DATE
APPROVED

DISAPPROVED

SIGNATURE AND TITLE OF TTB OFFICIAL, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

TTB F 5120.25 (72006)

DATE

wine. Describe any alternating areas. Each wine premises building
will be described as to size, construction and use. Buildings not used
for the wine operations will be described only as to size and use. If
wine premises consists of a partial building, rooms or floors, each will
be described separately. Means of ingress and egress from the wine
premises to adjoining portions will be described.

GENERAL INSTRUCTIONS
1.

Each person desiring to conduct the operations of a bonded wine cellar, a
bondedwinery,or a taxpaid wine bottling house shall file this application, in
duplicate, with the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau (TTB).

2.

The application information required will be on letter-sized paper with each
attached page identified with the name of the applicant, the serial number of the
application and the number of the page.

3.

The proprietor is responsible for keeping information of an approved application
current and complete. When required by 27 CFR Part 24, the proprietor shall
submit an amended application with supplemental or replacement pages or other
documents necessary to update the previously approved application. Replace
ment pages shall be numbered to correspond to the pages being replaced.

4.

If this application is for a taxpaid wine bottling house, paragraphs 7 through 9 of
the specific instructions are not applicable.

5.

Applications which are not submitted in accordance with the instructions on this
form and in 27 CFR Part 24 or which do not otherwise contain required
information will be returned to the applicant for correction.

6.

No wine may be produced or received until the premises and operations are
approved by the Director, National Revenue Center.
SPECIFIC INSTRUCTIONS

1.

SERIAL NUMBER. Applications on this form will be serially numbered,
commencing with serial number 1 for original establishment, and continuing in
sequence for each subsequent application. Applications for a taxpaid wine
bottling house will be filed separately and likewise begin with serial number 1.

2.

NAME AND ADDRESS. The address will be stated as explicitly as possible
with a ZIP Code. If located in a city, the numbered street address and the
name of the city will be given. If a rural address, give the name of the county
and nearest post office,with the approximate distance and direction therefrom,
including the name or number of the road or highway on which situated.

3.

BUSINESS ORGANIZATION. If already on file with TTB for another premises,
only reference that premises (§ 24.109(k)). If not, attach a statement of the type
of business organization, e.g., sole owner, partnership, corporation, and
of the persons having an interest in the business, supported by the
following:
For corporations:

5.

DISCLOSURE. If this application is not for a bonded wine premises in which
production operations will be conducted and, thus a Federal Alcohol
Administration Act basic permit is not required, would you agree to the listing
of your name in an TTB publication which may be distributed to the general
public upon request? A “no” response will have no effect on the consideration of
this application. Under 26 U.S.C. 6103, you have a legal right not to
give this release.

6.

TRADE NAME. List each trade name to be used in connection with the wine
operations. If State or local law requires registration, certify that each trade
name is registered. State the operating name if other than the name in Item 6.
If a trade name is listed in any basic permit issued, such trade name is not
required to be included in this application.

7.

SPIRITS OPERATIONS. Describe any operation which will involve the use of
spirits.

8.

BONDS AND PERMITS. With respect to this application, list all basic permits
and bonds (including those filed with this application) showing the name and the
surety for each bond.

9.

VOLATILE FRUIT-FLAVOR CONCENTRATE OPERATIONS. For volatile fruitflavor concentrate producers, submit a step-by-step description of the
production process, commencing with obtaining the juice through each step of
the process to removal of the concentrate from the system. For production of
high-proof concentrate (more than 24 percent alcohol), indicate any step in the
process at which the spirits are potable. Include the maximum quantity in
gallons of fruit must and volatile fruit-flavor concentrate produced in 24 hours;
the maximum and minimum fold; and the maximum percent of alcohol in the
concentrate for each kind of fruit used.

10. OTHER OPERATIONS. Describe any other operations not specifically
authorized by Part 24 that are to be conducted on the wine premises. This will
include a list of the premises and any major equipment used, and a statement
as the relationship, if any, of the operation to the wine operations. These other
operations need not be restricted to alcohol-related businesses.
PRIVACY ACT INFORMATION
The following information is provided pursuant to Section 3 of the Privacy Act of 1974 (5
U.S.C.§552a (e)(3)):
1.

AUTHORITY. Solicitation of this information is made pursuant to 26 U.S.C. §5172.
Disclosure of this information by the applicant is mandatory if the applicant wishes to
obtain authorization for operating a bonded wine cellar, a bonded winery, or a taxpaid
wine bottling house.

2.

PURPOSE. To identify the applicant, to identify the nature, location, and the extent of
the premises, the specific type or types of operations to be conducted on the premises,
and to determine the eligibility of the applicant to register the wine premises.

3.

ROUTINE USES. The information will be used by TTB to make determinations set
forth in paragraph 2. In addition, the information may be disclosed to other Federal,
State, foreign and local law enforcement and regulatory agency personnel to verify
information on the form where such disclosure is not prohibited by law. The
information may further be disclosed to the Justice Department if it appears tht the
furnishing of false information may constitute a violation of Federal law. Finally, the
information may be disclosed to members of the public in order to verify the
information on the form where such disclsoure is not prohibited by law.

4.

EFFECTS OF NOT SUPPLYING REQUESTED INFORMATION. Failure to supply
complete information will delay processing and may result in the denial of the
application.

(a) Corporate charter or certificate of corporate existence or incorporation.
(b) Names and addresses of officers and directors.
(c) Certified extracts of minutes, authorizing certain individuals to sign.
(d) Statement showing the number of shares of each class of stock, authorized
and outstanding, and the voting rights of the respective owners or
holders.
(e) Statement of interest: Names and addresses of the 10 persons having the
largest ownership or other interest in each class of stock, and nature and
amount of the stockholding or other interest of each, whether the interest
appears in the name of the interested party or in the name of another party.
The Director, National Revenue Center may request the
names of interested persons if applicant corporation is whollyowned or controlled by another corporation.
For partnerships:

PAPERWORK REDUCTION ACT NOTICE

(a) True copies of articles of partnership, if any, and of the certificate of
partnership where required to be filed by local authority.
4.

WINE PREMISES. Describe each tract of land comprising the wine premises.
Description will be by directions and distances, in feet and inches, with
sufficient particularity to enable ready examination of the boundary of the wine
premises. Describe the means employed to afford security of the wine
premises. Describe any taxpaid wine premises at the wine premises and the
means used to segregate and identify taxpaid wine from untaxpaid

This request is in accordance with the Paperwork Reduction Act of 1995. This information
collection is used by TTB to determine if the applicant is eligible to receive an alcohol or a tobacco
permit. The information is required to obtain a benefit.
The estimated average burden associated with this collection of information is 15 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
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.

TTB F 5120.25 (7/2006)