Form TTB F 5150.18 TTB F 5150.18 User's Report of Denatured Spirits

OMB No. 1513-0012 (11/30/2009)
FOR TTB USE ONLY

DEPARTMENT OF THE TREASURY

AUDITED BY (Initials)

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

1. REPORT FOR YEAR ENDING
JUNE 30, 20_______________

DATE

USER'S REPORT OF DENATURED SPIRITS
2. NAME AND ADDRESS OF PERMITTEE (Number, street, city, State and Zip Code)

3. INDUSTRIAL USE PERMIT NUMBER

4. THIS REPORT COVERS ONLY (Check one)
SPECIALLY DENATURED ALCOHOL (SDA)
SPECIALLY DENATURED RUM (SDR)
RECOVERED COMPLETELY DENATURED ALCOHOL
RECOVERED ARTICLES

CODE
NUMBER
(a)

FORMULA
NUMBER
(b)

QUANTITY USED
NEW
(c)

RECOVERED
(d)

QUANTITY
RECOVERED
(e)

CODE
NUMBER
(a)

5.

14.

6.

15.

7.

16.

8.

17.

9.

18.

10.

19.

11.

20.

12.

21.

13.

22.

FORMULA
NUMBER
(b)

QUANTITY USED
NEW
(c)

RECOVERED
(d)

QUANTITY
RECOVERED
(e)

TOTAL THIS REPORT

Under penalties of perjury, I declare that I have examined this report (including any accompanying explanations, statements, and schedules) and, to the best of my knowledge and belief, it is a true, correct,
and complete report and includes all transactions required by law or regulations to be reported.
23. DATE

24. PROPRIETOR (Complete only if different from Permittee)

25. SIGNATURE AND TITLE

TTB F 5150.18 (06/2007)

GENERAL INSTRUCTIONS
Reports for each year from July 1 through June 30 must be submitted on this form by every person who uses specially denatured spirits or recovers specially denatured spirits or articles. A person who
discontinues business during the year, and who otherwise would be required to file an annual report, must file a report (marked "Final Report") of transactions from July 1 to the date of discontinuance.
Transactions involving the recovery of completely denatured spirits or articles need not be included in annual reports. Only the use of recovered CDA or recovered articles is required to be reported.
Preparation: Prepare reports in duplicate. Report gallons to the nearest tenth. A separate report is required for each type of spirit (alcohol/rum) reported.
Submission Date: Submit the original of each report to the Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215, by the
15th day of each July. Retain the duplicate copy of each report for your records. This report must be retained for 3 years after submission.

SPECIFIC INSTRUCTION
Make a single entry to cover all specially denatured spirits of one formula used under one code number even though it may have been used in two or more processes (Lines 5 through 21).

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information is to monitor the operations of industries regulated by TTB. The information is required to
verify unusual activities, errors, omissions, and changes in periodic reports submitted by users of denatured spirits. The information is mandatory by statute (26 U.S.C. 5275).
The estimated average burden associated with this collection of information is 18 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 F 5150.18 (06/2007)