Form TTB F 5520.3 TTB F 5520.3 Registration of Volatile Fruit-Flavor Concentrate Plant

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DEPARTMENT OF THE TREASURY-- ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

REGISTRATION OF VOLATILE FRUIT-FLAVOR CONCENTRATE PLANT
(PREPARE IN DUPLICATE. SEE INSTRUCTIONS BELOW)

3.
TO

2. DATE

PART I — APPLICATION
DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND TOBACCO TAX AND TRADE
BUREAU, 550 MAIN ST, STE 8002, CINCINNATI, OH 45202-5215

5. APPLICANTS NAME AND PRINCIPAL BUSINESS ADDRESS
(Number and street, city, State and ZIP Code. If rural address, show
county, name or number of highway, and approximate distance and
direction from applicant's post office)

7. PURPOSE FOR WHICH FILED:

ORIGINAL REGISTRATION

OMB No. 1513-0006 (8/31/2008)
1. SERIAL NUMBER (Number in sequence
starttng with "1" for original registration)

4. REGISTRY NUMBER

6. PLANT ADDRESS (If different from business address. Enter in same
detail as asked for in item 5)

CHANGES AFTER ORIGINAL ESTABLISHMENT
(Explain)

OTHER
(Specify)

8. INFORMATION REGARDING PROPRIETORSHIP (State whether sole proprietorship, partnership, association, corporation, etc, and
furnish information regarding business organization as required by 27 CFR Part 18) (see instruction 3 below)

9. DESCRIPTION OF STILLS (List separately each still and condenser by serial number, kind, capacity in wine gallons of distillate
per hour, and intended use)

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS APPLICATION, INCLUDING THE DOCUMENTS SUBMITTED IN
SUPPORT HEREOF OR INCORPORATED HEREIN BY REFERENCE, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT,
AND COMPLETE.
10. SIGNATURE

11. TITLE

REMARKS

PART II — REGISTRATION
EFFECTIVE DATE
Approved for registration effective as of date Indicated.
SIGNATURE OF DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND TOBACCO
TAX AND TRADE BUREAU
TTB F 5520.3 (04/2008)

DATE

INSTRUCTIONS
1.

Submit each application, in duplicate, to the Director, National
Revenue Center, Alcohol and Tobacco Tax and Trade Bureau,
550 Main St, Ste 8002, Cincinnati, OH 45202-5215, the
application consists of this form and all papers and documents
required by the instructions on the form, or by 27 CFR Part 18
to be furnished as part of the application.

2. Information required by the various items may be furnished on
letter size paper attached to the form. Each sheet must
identify the applicant, this form and the serial number thereof,
and the number and title of the item being reported.
3. As to item 8, include as applicable:
(a) Extracts from the articles of incorporation, or from the
minutes of meetings of the board of directors. authorizing the
incumbents of certain offices, or other persons, to sign for the
corporation;
(b) Names and addresses of the officers and directors;
(c) Names and addresses of the 10 persons having the largest
ownership or other interest in the corporation, or other legal
entity, and the nature and amount of the stockholding or other
interest of each, whether such interest appears in the name of
the interested party or in the name of another for him/her;
(d) In the case of an individual owner or a partnership, the
name and address of every person interested in the concentrate plant, whether such interest appears in the name of the
interested party or in the name of another for him/her.

If any of the information specified above is already on file with the
Director, National Revenue Center, in connection with another
establishment under the same ownership, such information may,
if accurate and complete, be made a part of this application if the
applicant makes a definitive reference thereto in item 8 and shows
the name and identifying number of the establishment for which
he/she submitted the information.
4. When a change occurs which affects the accuracy or completeness
completeness
of any information
or document
furnished
in connectof
any information
or document
furnished in
connection
with
tion with registration
of the
plant,
an amended
application
registration
of the plant,
submit
ansubmit
amended
application
to the
Director,
National
Revenue
Center,Center,
as prescribed
in 27 CFR
PartCFR
18.
to the Director,
National
Revenue
as prescribed
in 27
Such
application
may be in
skeleton
form. Items
which
arewhich
Part 18.
Such application
may
be in skeleton
form.
Items
correctly
set forth
in prior
applications
and unchanged
may may
be be
are correctly
set forth
in prior
applications
and unchanged
incorporated
incorporated in
in the
the amended
amended application
application by
by reference.
reference. Such
incorporation
by reference
is made
by entering
for such
in the
Such incorporation
by reference
is made
by entering
for item
suchm
space
provided
therefore
the statement
"No change
since filing
in
the space
provided
therefore
the statement
"No change
since filform
5520.3
Ser.Ser.
No.___________"
(insert
serial
number).
ing
form
5520.3
No.___________"
(insert
serial
number).
5. When so instructed by the Director, National Revenue Center,
applicants are required to furnish as part of the application such additional information as may be necessary for the Director,
National Revenue Center to determine whether the application
should be approved.

6. In
thecase
caseofofaapartnership,
partnership,the
theapplication
applicationmust
mustbe
besigned
signedby
byall
all
In the
partners,or
orby
byaapartner
partner
duly
authorized
to sign
in behalf
of the
partners,
duly
authorized
to sign
in behalf
of the
firm, or
orby
byaaduly
dulyauthorized
authorizedattorney-in-fact.
attorney-in-fact.In In
case
firm,
thethe
case
of of
a corporation,
be executed
in the corporate
pplication
mustthe
be application
executed inmust
the corporate
name,
name, followed
bysignature
the signature
capacityofofthe
the person
person duly
followed
by the
andand
capacity
duly
authorized to
to act
act in
in its
its behalf.
behalf.
authorized

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. 5511(3). Disclosure of this information by the applicant is mandatory
if the applicant wishes to register his volatile fruit flavor plant.
2. PURPOSE. To identify the applicant, the location, the capacity of the premises, the capacity of the plant, and to determine the
eligibility of the applicant to register the plant.
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 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 that 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 when such disclosure is not prohibited by law.
4. EFFECTS OF NOT SUPPLYING INFORMATION REQUESTED. Failure to supply complete informatiuon will delay processing and may
result in the denial of the application.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine the
eligibility of the applicant to engage in certain operations, to determine location and extent of operations, and to determine
whether the operations will be in conformity with Federal law and regulations. The information requested is required to obtain or
retain a benefit, and is mandatory by statute (26 USC 5511). The individual must apply to seek and is required to obtain a benefit.
The estimated average burden associated with this collection is 2 hours per respondent or recordkeeper, depending on individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be
directed 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.

TTB F 5520.3 (04/2008)