Form TTB F 5200.3 TTB F 5200.3 Application for a Permit as a Manufacture of Tobacco Pro

OMB No. 1513-0078 (12/31/2008)
FOR TTB USE ONLY

DEPARTMENT OF THE TREASURY

Number

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

APPLICATION FOR A PERMIT AS A MANUFACTURER OF TOBACCO
PRODUCTS OR AN EXPORT WAREHOUSE PROPRIETOR

Date

1. I am applying for a TTB permit to conduct business as a:
Manufacturer of Tobacco Products

Proprietor of an Export Warehouse

OR

2. I am applying because:
I am starting a new business as stated in item 1.
I am taking ownership of an existing business as of
permit; or,
if the permit is not available, their name and their TTB permit number are

(enter date) and have attached their TTB

There has been a change in control in the corporation of the business as of
their TTB permit. If the permit is not available, state their name and TTB permit number:

(enter date), and I have attached

3. My legal name is (Read instruction H):

4. My employer identification number is (Read instruction I) :
5. My trade name or names are (Read instruction J):

6.

I have attached my trade name(s) certificate(s) (Read instruction K)
OR
I have NOT attached these certificates for the following reason:

7. The mailing address for my factory as a manufacturer of tobacco products or export warehouse is: (Note: TTB will use this address to
correspond with you.)

8.

I have attached a description and, if necessary, a diagram of my factory or export warehouse (Read instruction L)
OR
I have NOT attached a description for the following reason:

9.

I have attached the documents of my business as required by instruction M.
OR
I have NOT attached documents for my business for the following reason:

10.

I have provided the information about each person (Read instructions N and O) on this form or as an attachment.
OR
I have NOT provided this information for the following reason:

a. Full Legal Name

b. Title and position in my business

c. Percent (%) of voting stock or interest held in my business as a
d. Dollar amount of investment in my business as a manufacturer of
manufacturer of tobacco products or an export warehouse proprietor.
tobacco products or as an export warehouse proprietor.
Do NOT include stock held by a corporation to determine the percent Current:
Anticipated:
of voting stock.

$

e. Name and address of the person(s) from whom the investment
comes

$

f. Reason for, or source of, investment. For example: savings, loan,
profits from other business, or gift

TTB F 5200.3 (10/2006)

Page 1 of 3

a. Full Legal Name

b. Title and position in my business

d. Dollar amount of investment in my business as a manufacturer of
c. Percent (%) of voting stock or interest held in my business as a
manufacturer of tobacco products or an export warehouse proprietor.
tobacco products or as an export warehouse proprietor.
Do NOT include stock held by a corporation to determine the percent Current:
Anticipated:
of voting stock.

$

e. Name and address of the person(s) from whom the investment
comes

a. Full Legal Name

$

f. Reason for, or source of, investment. For example: savings, loan,
profits from other business, or gift

b. Title and position in my business

d. Dollar amount of investment in my business as a manufacturer of
c. Percent (%) of voting stock or interest held in my business as a
manufacturer of tobacco products or an export warehouse proprietor.
tobacco products or as an export warehouse proprietor
Do NOT include stock held by a corporation to determine the percent Current:
Anticipated:
of voting stock.

$

e. Name and address of the person(s) from whom the investment
comes

11.

$

f. Reason for, or source of, investment. For example: savings, loan,
profits from other business, or gift

I have identified for item 10 the person(s) having actual or legal control over my business (Read instructions N and P) .
OR
I have identified the person(s) having actual or legal control over my business (Read instructions N and P) BY attaching to this application
the information as required by item 10 WITH a statement on how actual or legal control is exercised.

12.

I have provided the information shown in the tables below for each person listed for items 10 and 11.
OR
I have NOT provided this information because of the following reason:

a. Full legal name

d.

Male
Female

b. Date and place of birth

e. Citizen or business of United States?
Yes

c. Social security or employer identification number

f. Other names used (maiden name, nicknames, etc.)

No (state country)
g. Residence(s), or place(s) of business, over the last five years

a. Full legal name

d.

Male
Female

b. Date and place of birth

c. Social security or employer identification number

e. Citizen or business of United States?
Yes

f. Other names used (maiden name, nicknames, etc.)

No (state country)
g. Residence(s), or place(s) of business, over the last five years

TTB F 5200.3 (10/2006)

Page 2 of 3

a. Full legal name

d.

Male
Female

b. Date and place of birth

e. Citizen or business of United States
Yes

c. Social security or employer identification number

f. Other names used (maiden name, nicknames, etc.)

No (state country)
g. Residence(s), or place(s) of business, over the last five years

a. Full legal name

d.

Male
Female

b. Date and place of birth

e. Citizen or business of United States?
Yes

c. Social security or employer identification number

f. Other names used (maiden name, nicknames, etc.)

No (state country)
g. Residence(s), or place(s) of business, over the last five years

13. Have you or any person listed in items 10 or 11 been denied a permit, license, or other authorization to engage in any business by any government agency (Federal, State, local, or foreign) or had such permit, license, or other authorization been revoked, suspended, or otherwise terminated?
Yes and I have attached the details of each occurrence to this application.

No

14. Have you or any person listed in items 10 or 11 been arrested for, charged with, or convicted of, any crime under Federal, State, or foreign laws?
(You do not have to include arrests, charges, or convictions for operating a motor vehicle that are not felonies under Federal or State law.)
Yes and I have attached the details of each occurrence to this application.

No

15. I declare that I have read the instructions for this form. I understand that I may need to file other TTB forms before TTB may act on this
application.
I understand that this application includes the information that I have attached to this form or incorporated by reference.
I understand that an appropriate TTB officer may require additional information to determine if I am entitled to the permit for which I am
applying.
Before TTB makes its final decision about this application, I will immediately write to the TTB supervisor of the office listed in instruction B if any
information for this application changes.
Under penalties of perjury, I have examined this application, and to the best of my knowledge and belief, this application, including any
attachments, is true, correct, and complete.
a. Signature

b. Title

d. E-mail address (optional)

e. Business telephone number

c. Date

How do I file this form? Send this form to the TTB National Revenue Center, 550 Main St, Ste 8002,Cincinnati, OH 45202-5215.
TTB F 5200.3 (10/2006)

Page 3 of 3

OMB No. 1513-0078 (12/31/2008)

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

APPLICATION FOR A PERMIT AS A MANUFACTURER OF TOBACCO
PRODUCTS OR AN EXPORT WAREHOUSE PROPRIETOR
GENERAL INSTRUCTIONS
A. Why do I need this form? If you want a permit to manufacture tobacco products or to operate an export warehouse under Chapter 52 of Title 26
of the United States Code (Internal Revenue Code), complete and file this form. Applying for this permit does not authorize you to operate
contrary to any Federal, State, or local laws.
B. How do I file this form? Send this form to the Director, National Revenue Center, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215. We
recommend that you keep a copy of what you send.
C. What are tobacco products? Cigars, cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own tobacco.
D. What is an export warehouse? A bonded internal revenue warehouse that stores tobacco products and cigarette papers and tubes on which
tax has not been paid and that will be shipped to a foreign country, Puerto Rico, the Virgin Islands, or a United States possession, or shipped for
consumption beyond the jurisdiction of the internal revenue laws of the United States.
E. Can I reference information that TTB already has on file? Yes, if you include:
(1) The name and address on the TTB form or the TTB permit number;
(2) The TTB form and item number; and
(3) The date that the TTB form was signed.
F. What if there is not enough space for my information? State that you have attached a separate sheet in the item number on this form.
G. When I attach information to this form, should I note it? Note any attachments to its item number and the TTB form number 5200.3.
INSTRUCTIONS FOR ITEMS ON THIS FORM
H. Item 3.

What is my legal name?
Your legal name is:

Your business is a:
Sole Proprietorship

Your full name.

Partnership

The name of each partner, or the name of the partnership as filed with a State or
local government.

Corporation, association, limited liability company, or other
business organization

The name as stated on your documents filed with the State or local government.

I. Item 4. What is my employer identification number? This is the nine-digit code that the Internal Revenue Service (IRS) assigns to your
business. If you do not have an employer identification number, you must file an IRS Form SS-4. You may get this form from the Internal
Revenue Service.
J. Item 5. What is a trade name? In general, a trade name is used to identify your business that is not its legal name. For example, your
legal name may be ABC Corporation, but you use ABC Tobacco Products in your business operations. Business operations include any name
with which you identify your business on invoices or letterhead. Also, business operations include a name that identifies your business on
packages of tobacco products or cigarette papers and tubes.
K. Item 6. Am I required to have a trade name certificate? Your State, county, or municipal authority may require a trade name certificate to
operate your business under a trade name. If your State, county, or municipal authority does not require a trade name certificate, state this fact
in item 6.
L. Item 8.
a. What must I include in my description? State the number, street, city, and state, of the location of your factory or export warehouse.
b. When do I need a diagram?
(1) Your factory or export warehouse is more than one building and each building cannot be identified by a separate street address.
Identify each building by a letter, number, or similar designation.
(2) Your factory or export warehouse uses only a part of a building. Show the floor and room(s) in the building.
(3) Your factory adjoins a retail store. Show any doors or other openings between the factory and the retail store.
c. Use of factory. Unless you have the authority from a TTB regulation or a letter written to you from an appropriate TTB officer, you cannot
use a factory for purposes other than those associated with the manufacture of tobacco products.
d. Use of export warehouse. Unless you have the authority from a TTB regulation or a letter written to you from an appropriate TTB officer,
you cannot use an export warehouse for other than the storage of tobacco products or cigarette papers or tubes.

TTB F 5200.3 (10/2006)

M. Item 9.

Business Documents.

Your business is a:

Attach to this application:

Partnership or association

Accurate copy of articles OR the certificate required to be filed by any State, county, or municipality.

Corporation

1. Accurate copy of the corporate charter OR certificate of corporate existence or incorporation. This copy
must be executed by the appropriate officer of the State in which incorporated.
2. Accurate copy of stockholders’ meetings, bylaws, or directors meetings that list the officers authorized to
sign documents or otherwise act on behalf of the corporation. The accuracy of the copy must be certified
by an appropriate officer of the corporation. The authority must exclude matters relating to laws and
regulations issued under Chapter 52 of Title 26 of the United States Code (Internal Revenue Code). You
can use TTB F 5100.1, Signing Authority for Corporate Officials, in place of this copy.

Limited liability company or other
business organization

Accurate copy of the business document(s) filed with a State, county, or municipality when such filing is
required. The copy must show that it was filed with the appropriate Government agency. For example, a
limited liability company must provide an accurate copy of its operating agreement.

N. Items 10 and 11 Who must I consider as a “person”? An individual, partnership, association, company, corporation, estate, or trust.
O. Item 10
a. Which persons must I list for item 10?
(1) Yourself, if you are the sole proprietor.
(2) Each partner if your business is a partnership.
(3) Each officer or director if your business is a corporation.
(4) Each position similar to an officer or director of a corporation if your business is another type of business organization.
(5) A manager of a limited liability company.
(6) A stockholder who holds more than ten percent of the stock of a corporation, limited liability company, or similar business organization.
(7) An investor who has or will contribute more than ten percent of the funds for the business.
b. What information must I provide for each person? If any information is not applicable, state so.
(1) Full legal name (if a business, read instruction H);
(2) Title and position in my business;
(3) Percent (%) of voting stock or interest held in my business as a manufacturer of tobacco products or as an export warehouse proprietor
(Do NOT include stock held by a corporation to determine the percent of voting stock) ;
(4) Dollar amount of current and anticipated investment in your business as a manufacturer of tobacco products or as an export warehouse
proprietor;
(5) The name and address of the person(s) from whom the investment comes; and
(6) The reason for, or the source of, the investment. For example: savings, loan, profits from other business or gift.
P. Item 11. Who exercises actual or legal control of my business? In general, a person who has the power or authority to manage, direct,
govern, or administer how your business operates.
Q. Item 15. Who may sign this application?
If your business is a:

The application must be signed by:

Sole proprietorship

You; OR
An individual for whom you have filed TTB F 5000.8, Power of Attorney.

Partnership

Each partner; OR
The partner who has been given the authority to sign by the articles of partnership or similar agreement of all
the partners that you have filed for this permit; OR
An individual for whom you filed TTB F 5000.8, Power of Attorney.

Corporation, association, limited
liability company, or other business
organization

An individual who has signature authority granted by the business documents that you have filed for this
application; OR
An individual for whom you have filed TTB F 5000.8, Power of Attorney.
QUESTIONS

R. If I have questions about this TTB form, who can answer my questions? Contact a specialist in the Tobacco Unit, National Revenue Center
by phone at 1-877-882-3277 or 1-513-684-7151, fax at 1-513-684-2251, or e-mail to [email protected].
STARTING BUSINESS
S. When I file this application, can I start the business for which I have applied?
Your reason for filing
To start the business

No, you must wait for TTB to grant your permit.

To report the pending transfer in the
ownership of the business

No, you must wait for TTB to grant your permit.

To report a change in control
corporation
1

1

of a

You may continue to operate if you file this form within 30 days of the change.

A change in control of a corporation occurs when the issuance, sale, or transfer of its stock results in changing the identity of the stockholders who
exercise actual or legal control of the corporation.
TTB F 5200.3 (10/2006)

T. When can I expect my permit? In general, it takes up to 16 weeks before TTB decides if you qualify. TTB thoroughly examines the
information that you provide with this application. If you omit information or provide partial information, it will take longer. Also, TTB may
request additional information based on the information that you have provided. If TTB decides not to issue the permit, you will receive a written
notice stating the reasons.
U. Must I file other TTB forms? If you are filing this application to start a new business or to take ownership of an existing business, you must:
a. Upon starting business, file TTB F 5630.5 and pay the tax; AND
b. If you are filing to operate as a manufacturer of tobacco products, File TTB F 5000.29, TTB F 5000.30, and TTB F 5210.3; OR
c. If you are filing to operate as an export warehouse proprietor, File TTB F 5220.5.
V. If TTB issues me a permit, what else is expected when I start my business? You must comply with TTB regulations. If you operate a
factory to manufacture tobacco products, read Part 40 of Title 27 of the Code of Federal Regulations. If you operate as an export warehouse
proprietor, read Part 44 of Title 27 of the Code of Federal Regulations. These parts of the TTB regulations are available from the TTB Web site
(http://www.ttb.gov) or the Government Printing Office Web site (http://www.gpoaccess.gov/index.html).

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. We use this information collection to determine your identity, location,
extent of operations, eligibility to engage in operations, and the likelihood that you will conform with Federal laws and regulations. This
information is required from you to obtain or retain a benefit and is mandatory by law (26 U.S.C. 5712).
We estimate that you will spend 2 hours to complete this form (average burden associated with this collection of information). You may spend more
or less time depending upon 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.
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.

PRIVACY ACT INFORMATION
The following information complies with Section 3 of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)):
1. What is TTB’s authority to ask for this information? We require this information under the authority of 26 U.S.C. 5712. You must provide this
information before TTB decides on whether your permit will be issued.
2. What is the purpose for this information collection? You must provide this information so that TTB will be able to determine your identity,
location, extent of operations, and eligibility to engage in operations, and the likelihood that you will conform with Federal laws and regulations.
3. How does TTB routinely use this information? We use this information to make determinations for the purposes described in paragraph 2.
Also, if we are not prohibited by law, we may disclose the information that you provided on this form to other Federal, State, foreign, or local law
enforcement or regulatory agency personnel, and to members of the public to verify it. Finally, we may disclose this information to the Justice
Department if it appears that false information, which constitutes a violation of Federal law, has been provided.
4. What is the effect if I do not supply the information TTB requests? If you fail to supply this information, then it will delay TTB’s determination
as described in paragraph 2. Also, TTB may disapprove your application if you fail to supply the information.
TTB F 5200.3 (10/2006)