Old Version of TTB F 5154.2

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

(PLEASE READ INSTRUCTIONS BELOW BEFORE COMPLETING THIS FORM)

MONTH

PART I - IDENTIFICATION DATA
2. PERIOD COVERED (CHECK ONE)
QUARTER
ENDING:

PAGE

OF

OMB No. 1513-0098 (10/31/2006)

4. TAX YEAR COVERED BY SPECIAL TAX STAMP

3. CONTROL NUMBER ON SPECIAL TAX STAMP

SUPPORTING DATA FOR NONBEVERAGE DRAWBACK CLAIMS
1. NAME AND ADDRESS OF CLAIMANT

No

$

(a)

$

$

(b)

$

(c)

$

(d)

$

PART II - DISTILLED SPIRITS ACCOUNT (IN PROOF GALLONS, EXCEPT LINES 1-2)
Was a physical inventory taken per 27 CFR 17.167 (a)? (Check one) New Spirits (eligible, not previously
SPIRITS RECOVERED
Eligible Spirits Content of Intermediate
used in intermediate or nonbeverage In the Manufacture of Intermediate In the Manufacture of Nonbeverage Products
products)
Products (eligible spirits)
Products (ineligible spirits)
Yes

1. KIND (optional, except for Puerto Rican or U.S. Virgin
Islands spirits, and imported rum)
2. EFFECTIVE TAX RATE PER PROOF GALLON
3. ON HAND, START OF PERIOD

7. PRODUCED

6. RECOVERED

5. RECEIVED

4. IN PROCESS, START OF PERIOD

DURING
PERIOD:

8. GAINS

12. OTHERWISE USED (not subject to drawback)

11. USED IN INTERMEDIATE PRODUCTS

10. USED IN NONBEVERAGE PRODUCTS

9. TOTAL TO ACCOUNT FOR (add lines 3-8)

DURING
PERIOD:

13. LOSSES
14. ON HAND, END OF PERIOD
15. IN PROCESS, END OF PERIOD
16. TOTAL ACCOUNTED FOR (add lines 10-15)
TTB F 5154.2 (5/2005)

INFORMATION FROM TTB FORM 5154. 1

PAGE

OF

FINISHED PRODUCT PRODUCED

ALCOHOL
CONTENT BY
VOLUME

ELIGIBLE SPIRITS USED

AMOUNT PRODUCED
(wine gals., except
dry products)

%

AMOUNT USED
(proof gals.)

$

%

DRAWBACK RATE
(= $1.00 less than
effective tax rate)

$

%

KIND (P.R. or V.I.
spirits, imported
rum, other kinds)

PART III - PRODUCTION OF NONBEVERAGE PRODUCTS
INELIGIBLE
RECOVERED
SPIRITS USED
(proof gals.)

1.

$

%

FORMULA NO. (or
“NF,” “USP” or
“HPUS”)

2.

$

%

NAME OF
PRODUCT

3.

$

%

(h)

4.

$

%

(g)

5.

$

%

(f)

6.

$

%

(e)

7.

$

%

(d)

8.

$

%

(c)

10.

$

%

(b)

11.

$

%

(a)

12.

$

9.

13.

%

DATE

$
PART IV - ADDITIONAL AND EXPLANATORY INFORMATION

SIGNATURE AND TITLE

TTB F 5154.2 (5/2005)

14.

I certify, under the penalties of perjury, that the data submitted
on this form are correct, to the best of my knowledge.

FORMULA NO. (or
“NF,” “USP” or
“HPUS”)
(c)

INELIGIBLE
RECOVERED
SPIRITS USED
(proof gals.)

PAGE

OF

KIND (P.R. or V.I.
spirits, imported
rum, other kinds)
(e)

DRAWBACK RATE
(= $1.00 less than
effective tax rate)

(f)

AMOUNT USED
(proof gals.)

(g)

AMOUNT PRODUCED
(wine gals., except
dry products)

(h)

ALCOHOL
CONTENT BY
VOLUME

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

%

FINISHED PRODUCT PRODUCED

(d)

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

ELIGIBLE SPIRITS USED

PART III - PRODUCTION OF NONBEVERAGAE PRODUCTS (Continued)

NAME OF PRODUCT
(Please number each line.)

(b)

INFORMATION FROM TTB FORM 5154. 1

(a)

TTB F 5154.2 (5/2005)

(4)

(3)

(2)

(B)

(4)

(3)

(2)

(A)

Note that column (d) only calls for the eligible spirits content of intermediate products, not the full volume of such products.

Gains (line 8) and losses (line 13) must be reported when determined, even if no physical inventory was required for that
claim period. Any gain reported in columns (a), (b), or (d) of line 8 shall be reflected by an equivalent deduction from the
amount of drawback claimed. Gains shall not be offset by losses. Note: Gains and losses determined on initial receipt of
spirits (see § 17.162(d)) are not reported in Part II; nevertheless, such gains must be reported in Part IV and deducted
from the claim.

In lines 4 and 15, spirits “ in process” are spirits contained in unfinished intermediate or nonbeverage products prior to the
time of “use” of the spirits as determined under § 17. 152. Spirits in process are distinguished by their source; thus, for
example, spirits “in process” in an unfinshed intermediate product would appear in column (a) if the spirits had not been
previously used, but they would appear in column (d) if they had come from other intermediate products.

Separate accounts shall be kept under Part II for spirits taxpaid at different effective tax rates. Separate accounts shall
also be kept for : (A) spirits from Puerto Rico containing at least 92% rum, (B) spirits from the U.S. Virgin Islands
containing at least 92% rum, and (C)imported rum. Theses separate accounts shall be maintained in columns (a), (b),
and (d). Only a single account is needed in column (c), since spirits reported there are ineligible for drawback. If desired,
additional separate accounts may be kept for other “kinds” (e.g. alcohol of various proofs in column (a), different products
in column (d), etc.). If more than two accounts are needed in any column, the form may be modified or Part II may be
photocopied.

PART II. (1) Persons filing claims under 27 CFR Part 26 for Puerto Rican or Virgin Islands products are not required to
complete Part II.

Supplies of this form may be obtained from [email protected] or 1-877-882-3277.

This form may be used by persons claiming drawback on nonbeverage products brought into the U.S. from Puerto Rico or
the U.S. Virgin Islands under the provisions of 27 CFR Part 26, as well as by domestic manufacturers claiming drawback
under 27 CFR Part 17. Certain instructions that only pertain to one of these types of claimants are so indicated.
Such instructions are not to be confused with instructions pertaining to use, by domestic manufacturers, of Puerto Rican or
Virgin Islands spirits.

Modifications of this form may be used without prior authorizatin, as long asall required information pertinent to the
manufacturing operation is shown. If certain lines or columns do not apply to an operation, then such lines or columns
may be omitted. In omitting lines or columns, the letter or numerical designations of the remaining lines and columns shall
not be changed. A continuation sheet for persons claiming on more than 14 products in Part III is on the reverse of these
instructions. The continuation sheet may be photocopied.

GENERAL. (1) Each claim for drawback shall be accompanied by supporting data containing the information presented by
this form. Regulations pertaining to this form are found in 27 CFR 17.147. All quantities of spirits shall be in proof
gallons. This form may be photocopied.

(4)

(3)

(2)

(D)

(7)

(6)

(5)

(4)

(3)

(2)

(C)

For claimants under 27 CFR Part 26 only: Part IV shall state the name and address of the manufacturer of each product
(if different from the claimant), the date of entry into the U.S. and the evidence of taxpayment as required by
§26.173(c)(2)(viii) or §26.309(c)(2)(viii).

For claimants under 27 CFR Part 17: If a deduction was taken from the amount of drawback claimed, due to a gain in a
shipment of spirits received(as required by § 17.162(d)) or to a gain in spirits on hand (as required by § 17.167(a)), this
shall be noted in Part IV.

For claimants under 27 CFR Part 17 only: if imported rum, or spirits from Puerto Rico or the U.S. Virgin Islands
containing at least 92% rum, were used subject to drawback in nonbeverage products. Part IV shall state the total
number of proof gallons so used during the period for each of those three categories. Such amounts shall include eligible
spirits or rum from intermediate products and eligible recovered spirits. Ineligible spirits shall not be included.

PART IV. (1) Part IV shall contain an explanation of any discrepancies (gains or losses) in the distilled spirits account
(Part II) recorded by the physical inventory required in § 17.167(a).

If distilled spirits were added, as described in § 17. 152(c), to a batch of nonbeverage product that was recorded as
completed during a previous claim period, such addition shall be recorded on a separate line in Part III. The amount
shown in column (f) in such a case shall be only the addition volume of finished product created by addition of the spirits,
and words such as “addition after assay” shall be added in column (a).

Yield of finished product (column (g)) shall be shown in wine gallons. For dry products, yield shall be shown in the same
units used to express yield in the approved formula, TTB F 5154.1.

In column (d), imported rum shall be distinguished from other rum; spirits from Puerto Rico or the U.S. Virgin Islands
shall be distinguished if(and only if) they contain at least 92% rum.

If spirits of more than one kind, or taxpaid at more than one effective tax rate, were used during the claim period in any
nonbeverage product, then the number of proof gallons for each kind and for each drawback rate shall be shown
separately by subdividing columns (d),(e), and (f). (This requirement does not pertain to claimants under 27 CFR Part 250.)

In column (c), show usage only of spirits recovered in the manufacture of nonbeverage products (i.e. spirits from the
account in column (c) of Part II). Note that usage of other ineligible spirits (i.e. spirits derived from nonbeverage
products) is not reported in Part III. Such usage must be shown in batch records, however, per § 17. 164(b).

For claimants under 27 CFR Part 26: Columns (c) and (d) are not required; column (e) is not required, but if completed
should read “$10.30”; column (f) should be used to state the proof gallons contained in each product (which may be less
than the amount used); column (g) should be used to show the amount of product brought into the U.S.

Part III. (1) In column (b), if a formula was adopted from another plant under § 17.125(b), the plant from which the
formula was adopted shall be indicated in addition to the formula number. This may be done by a letter or other symbol if
the meaning is explained in Part IV.

INSTRUCTIONS FOR TTB F 5154.2

(5)

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. This form is used by TTB to verify that products on which drawback is claimed were made according to approved nonbeverage
formulas, and that regulatory requirements have been met. The information is required to obtain a benefit.

The estimated average burden associated with this collection of is 1 hour per respondent or recordkeepeer, depending on individual circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be addressed to Reports Management Office, Regulations and Procedures 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 currently valid OMB control number.

TTB F 5154.2 (5/2005)