Form TTB F 5170.7 TTB F 5170.7 Application and Permit to Ship Liquours and Articles of

OMB No. 1513-0008 (12/31/2008)
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

1. SERIAL NUMBER

APPLICATION AND PERMIT TO SHIP LIQUORS AND ARTICLES OF PUERTO RICAN
MANUFACTURE TAXPAID TO THE UNITED STATES
PART I — APPLICATION
To The Secretary of the Treasury of Puerto Rico
Application is made to ship the following liquors or articles of Puerto Rican manufacture to the United States in
bottles and cases

(Check one)

packages
DESCRIPTION OF LIQUORS OR ARTICLES

SERIAL NOS.
OF PACKAGES

KIND OF
LIQUOR OR
ARTICLE

(a)

(b)

NO. OF

SIZE

BRAND NAME

CASES
OR

OF
BOTTLES

(c)

(d)

PKGS
E

FORM NUMBER

2. FORMULA
(If any)

(e)

NO. OF
BOTTLES
PER
CASE
(f)

CONTENTS
WINE
GALS.

PROOF

PROOF
GALS.

(g)

(h)

(i)

RATE
OF
I. R.
TAX
(j)

AMOUNT OF
TAX
(k)

DATE APPROVED

SERIAL NUMBER (If any)

3. TO BE SHIPPED BY (Name of vessel)

4. TO (Port of arrival in U.S.)

5. NAME OF CONSIGNEE

6. ADDRESS OF CONSIGNEE

Under the penalties of perjury, I declare that the taxes equal to the Internal Revenue taxes imposed on like liquors and articles in the United States have been
paid or deferred on such liquors or articles, as prescribed by regulations in 27 CFR Part 26, and that this application and the statements therein have been
examined by me and, to the best of my knowledge and belief, are true, correct, and complete.
7. DATE

8A. BY (Signature and Capacity)

8. APPLICANT

PART II - CERTIFICATE OF INTERNAL REVENUE AGENT
To The Secretary of the Treasury of Puerto Rico
I hereby certify that taxes equal to the Internal Revenue taxes imposed on like liquors or articles in the United States have been paid or deferred on the
liquors or articles described in Part I, as prescribed by regulations in 27 CFR Part 26.
9. DATE

10. REVENUE AGENT

-

PART III - PERMIT TO SHIP
Permit is hereby granted to the applicant designated in Item 8 to ship to the United States the liquors or articles described in Part I.
11. DATE

12. SECRETARY

12A. BY

PART IV — CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION IN PUERTO RICO
I hereby certify that, except as noted in Item 15, the liquors or articles described in Part I were duly inspected and laden for shipment to the United States.
13. NAME OF VESSEL

14. BOUND FOR PORT OF

15. EXCEPTIONS
16. DATE

DDDDDDDDD
TTB FORM 5170.7 (05/2007)

17. CUSTOMS AND BORDER PROTECTION OFFICER

18. AREA PORT DIRECTOR

PART V-- CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION AT PORT OF ARRIVAL IN UNITED STATES
I hereby certify that the liquors or articles described in Part I were received and have been inspected and released as follows:
19. DATE

20. PORT OF

21. QUANTITY INSPECTED AND RELEASED

22A. Identify separately the quantity lost from each container and the serial number of each container.
CONTAINER SERIAL NUMBER

QUANTITY LOST1

22. Lost by breakage or otherwise during
transportation to the United States.

TOTAL QUANTITY LOST1

23. CUSTOMS AND BORDER PROTECTION OFFICER

24. AREA PORT DIRECTOR

1

Identify, as applicable, in terms of "proof gallons" (spirits), "wine gallons" (wine), or "barrels" (beer)

1. GENERAL. The shipper must prepare this form in sextuplet for each
consignment. A separate TTB F 5170.7 is required for each product
covered by an approved formula. Forms must be serially numbered
beginning with "1" each calendar year, and running consecutively
thereafter to the end of the year. The serial number must be prefixed by
the last two digits of the calendar year, e.g., 07-1."
2. PART I. The shipper must prepare Part I. Where the shipment covers
wine, enter the tax class of the wine in column 2(h) and disregard column
2(i). Where the shipment covers beer, modify the heading of column 2(g)
to read "barrels" and enter quantity in barrels; disregard columns 2(h) and
2(i). After executing his/her application in Part I, the shipper must deliver
all copies of the form to the Internal Revenue Agent.
3. PART II. After executing his/her certificate in Part ll, the Internal
Revenue Agent must forward all copies of the form to The Secretary of the
Treasury of Puerto Rico.
4. PART III. After executing his/her permit to ship on all copies of the form,
the Secretary must retain one copy, send the original and two copies to the
Area Port Director in Puerto Rico, and return two copies to the shipper.

The shipper must then submit the two copies to the Area Port Director
in Puerto Rico at least six hours prior to the intended lading of the
merchandise.
5. PART IV. The Area Port Director in Puerto Rico, on release of the
merchandise for shipment, must execute his/her certificate in Part IV on
all copies, retain one copy for his/her files, mail the original to the Director
of Customs at the port of arrival in the United States, dispatch a second
copy to said Port Director on the vessel concerned for the guidance of the
inspector who will handle the cargo, and return two copies to the shipper.
After the shipment has been cleared, the shipper must retain one copy of
the form and send one copy, with other shipping documents, to the Area
Port Director at the port of arrival.
6. PART V. The Area Port Director at the port of arrival in the United
States, after executing his certificate on all copies of the form received by
him/her, must retain the original for his/her files, and forward the two
remaining copies to the District Director, Puerto Rico Operations, TTB,
Ste 310 Torre Chardon, 350 Carlos Chardon Ave, San Juan, PR 00918

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection documents transactions of taxable commodities
on which tax has not been paid. TTB uses the information to determine that the transaction is in accordance with laws and regulations and establish
the person responsible for the tax involved in the transaction. Information requested is mandatory by statute (26 USC 5314 and 7652).
The estimated average burden associated with this collection of information is 30 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 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 FORM 5170.7 (05/2007)