Form TTB F 5200.16 TTB F 5200.16 Application for an Amended Permit as a Manufacture of To

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

Date

(enter permit number) to conduct business as a:

1. My TTB permit

Proprietor of an Export Warehouse

OR

Manufacturer of Tobacco Products

2. My employer identification number is: (Read instruction H)
3.

I have attached my permit to this TTB form for amendment (Read instruction I).
OR
I have NOT attached my permit to this application because:

4. My new legal name is (Read instruction J):

AND

I have attached the document(s) to show this change.
OR
I have NOT attached the document(s) to show this change because:

5.

I am changing, discontinuing, or adding the trade name(s) (Read instruction K) as follows:
Remove trade name(s) from my permit:

Add trade name(s) to my permit:

6.

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

7.

I I am reporting that the mailing address of my factory to manufacture tobacco or my export warehouse has changed, but not its location, to:

8. I intend to relocate, extend, or curtail my factory to manufacture tobacco products, or my export warehouse (Read instruction M).
I have attached a description and, if necessary, a diagram of my factory or export warehouse.
OR
I have NOT attached a description for the following reason:
9.

I am reporting a change in the officers or directors of a corporation, association, or similar business.
I am reporting a change in the stockholder(s) holding more than 10 percent of a corporation, limited liability company, association, or similar
business.
I am reporting a change in the manager of a limited liability company as follows:

a. REMOVE the following persons (Read instruction N) from my business:
a. Full legal name
b. Title(s) or position in business

c.

Social security or employer identification number

a. Full legal name

b. Title(s) or position in business

c.

Social security or employer identification number

a. Full legal name

b. Title(s) or position in business

c.

Social security or employer identification number

a. Full legal name

b Title(s) or position in business

c

TTB F 5200.16 (09/2008)
Page 1 of 3

Social security or employer identification number

b. ADD the following new persons (Read instruction N) with their information as stated below or as an attachment.
(1) Full legal name

(4)

Male
Female

(2) Date and place of birth

(3) Social security or employer identification number

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

(5) Citizen or business of United States?
Yes
No (state country)

(7) Residence(s) or place of business over the last five years

(8) Title and position in my business
(10) Dollar amount of investment in my business as a manufacturer of
(9) Percent (%) of voting stock or interest held in my business as a
manufacturer of tobacco products or an export warehouse propritobacco products or as an export warehouse proprietor
etor. Do NOT include stock held by a corporation to determine the Current
Anticipated
percent of voting stock.

$

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

(1) Full legal name

(4)

Male
Female

$

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

(2) Date and place of birth

(3) Social security or employer identification number

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

(5) Citizen or business of United States?
Yes
No (state country)

(7) Residence(s) or place of business over the last five years

(8) Title and position in my business
(10) Dollar amount of investment in my business as a manufacturer of
(9) Percent (%) of voting stock or interest held in my business as a
manufacturer of tobacco products or an export warehouse propritobacco products or as an export warehouse proprietor
etor. Do NOT include stock held by a corporation to determine the Current
Anticipated
percent of voting stock.
$
$
(11) Name and address of the person(s) from whom the investment
comes

(1) Full legal name

(4)

Male
Female

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

(2) Date and place of birth

(3) Social security or employer identification number

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

(5) Citizen or business of United States?
Yes
No (state country)

(7) Residence(s) or place of business over the last five years

(8) Title and position in my business
(10) Dollar amount of investment in my business as a manufacturer of
(9) Percent (%) of voting stock or interest held in my business as a
manufacturer of tobacco products or an export warehouse propritobacco products or as an export warehouse proprietor
etor. Do NOT include stock held by a corporation to determine the Current
Anticipated
percent of voting stock.
$
$
(11) Name and address of the person(s) from whom the investment
comes

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

Page 2 of 3

TTB F 5200.16 (09/2008)

10. Has any person listed in item 9b. 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 revoked, suspended, or otherwise terminated.
Yes, and I have attached the details of each occurrence to this application.

No

11. Has any person listed in item 9b. been arrested for, charged with, or convicted of, any crime under Federal, State, or foreign laws?
(You do not have to include arrests, charge s, 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

12. I declare that I have read the instructions for this form including the need to file other TTB forms. I understand that I may need to file these 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 to which I have made a reference.
I understand that an appropriate TTB officer may require additional information to determine that I am entitled to the amended permit for which I
am applying.
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 (See instruction O)

b. Title

d. My e-mail address (optional)

e. My business telephone number

c. Date

How do I file this form? Send this form to the TTB National Revenue Center, 550 Main Street, Ste. 8002, Cincinnati, OH 45202.

TTB F 5200.16 (09/2008)

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 AMENDED PERMIT AS A MANUFACTURER OF
TOBACCO PRODUCTS OR AN EXPORT WAREHOUSE PROPRIETOR
GENERAL INSTRUCTIONS
A. Why do I need this form? Use this form to amend your 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). Also, you may use this form to notify TTB of certain changes in your
business. Applying for an amended permit does not authorize you to operate contrary to any Federal, State, or local laws.
B. When do I have to file this form to amend my permit and do I have to wait for TTB to approve it?
REASON

WHEN TO FILE

WAIT FOR TTB
APPROVAL

Relocating your factory to manufacture tobacco products or your export warehouse

Before relocating

Yes

Changing the address (not the location) of your factory or export warehouse

Within 30 days of the change

No

Extending or curtailing your factory or export warehouse that affects the accuracy of it
description, and, if any, diagram that you filed with TTB.

Before extending or curtailing

Yes

Changing, discontinuing, or adding a trade name used in your business operations as
manufacturer of tobacco products or an export warehouse proprietor.

Within 30 days

No

Within 30 days

No

If the change affects the identity
of the person who is authorized
to sign, immediately; otherwise,
within 30 days.

No

Changing your legal name.

1

Changing officers or directors of a corporation, association, or similar business.
Changing stockholder(s) holding more than 10 percent of a corporation, limited liability
company, association, or similar business. 2
Changing the manager of a limited liability company.
1

2

A change in name often occurs as a result of a transfer of ownership. If there is a transfer of ownership, then you must file TTB F 5200.3,
not this form.
A change in officers, directors, or stockholders of a corporation may result in a change in control. If a change in control occurs, you must file
TTB F 5200.3, not this form.

C. How do I complete this form? Complete items 1, 2, 3, and 12, and applicable items in the following table:
REASON FOR FILING

ITEM(S)

Relocating your factory to manufacture tobacco products or your export warehouse.

8

Changing the address (not the location) of your factory or export warehouse.

7

Extending or curtailing your factory or export warehouse that affects the accuracy of its description, and, if any, diagram that you
filed with TTB.

8

Discontinuing a trade name used in your business operations as a manufacturer of tobacco products or an export warehouse
proprietor.

5

Changing or adding a trade name used in your business operations as a manufacturer of tobacco products or an export
warehouse proprietor.

5 and 6

Changing your legal name.

4

Changing officers or directors of a corporation, association, or similar business

9, 10, and 11

Changing stockholder(s) holding more than 10 percent of a corporation, limited liability company, association, or similar business

9, 10, and 11

Changing the manager of a limited liability company.

9, 10, and 11

D. How do I file this form? Send this form to the TTB National Revenue Center, 550 Main Street, Ste. 8002, Cincinnati, OH 45202.
We recommend that you keep a copy of what you send.
E. Can I incorporate 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 it in the item 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 - 5200.16.
TTB F 5200.16 (09/2008)

INSTRUCTIONS FOR SPECIFIC ITEMS
H. Item 2. What is my employer identification number? This is the nine-digit code that the Internal Revenue Service (IRS) has assigned to your
business. If you do not have this number, you must file an IRS Form SS-4, which is available from the Internal Revenue Service.
I. Item 3. When do I have to attach my permit? You must always attach your permit except when you are ONLY reporting a change of officers,
directors, or stockholders of a corporation, association, or similar business. If you cannot locate your permit, you must state this fact.
J. Item 4.
a. 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.

b. What documents must I file?
If your business is a:
Sole Proprietorship
Partnership or association
Corporation

Limited liability company or other
business organization

Attach to this application:
Accurate copy of certificate, issued by State, county, or municipality, which shows the change in your name.
Accurate copy of articles OR the certificate required to be filed by any State, county, or municipality.
Accurate copy of the corporate charter OR certificate of corporate existence or incorporation, or other
corporate document that shows your new legal name. This copy must be executed by the appropriate officer
of the State in which your business is incorporated.
Accurate copy of the business document(s) that shows your new legal name 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.

K. 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.
L. 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.
M. 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. Can I use a factory? No. Not unless you have the authority from an 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. Can I use an export warehouse? No. Unless you have the authority from an TTB regulation or a letter written to you from an appropriate
TTB officer, you cannot use an export warehouse for anything other than the storage of tobacco products, or cigarette papers or tubes.
N. Item 9.
a. Who must I include as a “person”? An individual, partnership, association, company, corporation, estate, or trust.
b. What information must I provide for each new person? If any information is not applicable, state so.
(1) Full legal name (Read instruction J);
(2) Date and place of birth;
(3) Social security or employer identification number;
(4) Sex (Male or female) ;
(5) Citizen or business of United States or name of country;
(6) Other names used (Maiden name, nicknames, etc.);
(7) Residence(s), or place(s) of business, over the last five years;
(8) Title and position in your business;
(9) Percent (%) of voting stock or interest held in your 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);
(10) Dollar amount of current and anticipated investment in your business as a manufacturer of tobacco products or as an export warehouse
proprietor;
(11) Name and address of the person(s) from whom the investment comes; and
(12) Reason for, or source of, funds. For example: savings, loan, profits from other business, or gift.

TTB F 5200.16 (09/2008)

O. Item 12. 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 an 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 an TTB F 5000.8, Power of Attorney.
An individual who has signature authority granted by the business documents that you have filed for this permit;
OR
An individual for whom you have filed an TTB F 5000.8, Power of Attorney.

Corporation, association, limited
liability company, or other
business

QUESTIONS
P. Are there any other TTB forms that I need to complete?
REASON FOR FILING

Other forms

Relocating your factory to manufacture tobacco products or your export warehouse.

Depends

3

Change in address (not the location) of your factory or export warehouse.

Depends

3

Extending or curtailing your factory or export warehouse that affects the accuracy of its description, and, if any, diagram that you
filed with TTB.

Depends

Changing, discontinuing, or adding a trade name used in your business operations as a manufacturer of tobacco products or an
export warehouse proprietor.

No

Your legal name has changed.

3

TTB F 2105 (5000.7)

Change in officers, directors, or stockholders of a corporation, association, or similar business.

No

3
You may be required to file a new bond or amend its coverage. If your bond form specifies the location of your factory (TTB F 5220.5) or your
export warehouse (TTB F 5210.3), you must file a new bond or an extension of the bond.

Q.

If I have questions about this TTB form, who can answer my questions? Contact a specialist at the TTB National Revenue Center by phone
at 1-877-882-3277 or 1-513-684-7151, fax at 513-684-2251, or e-mail to [email protected] or [email protected].

R. When can I expect my permit? In general, it takes from 2 to 12 weeks before TTB decides on amending your permit. 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 amended permit, you
will receive a written notice stating the reasons.
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, and 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 1 hour 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 a collection of information unless it displays a current valid OMB control number. In addition, you are 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 you may continue your business allowed under this permit.
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 5200.16 (09/2008)