Form TTB F 5120.24 TTB F 5120.24 Drawback on Wine Exported

OMB No. 1513-0016 (01/31/2010)
1. SERIAL NUMBER (The exporter will number
each form beginning with "1" each January 1.)

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

DRAWBACK ON WINES EXPORTED
(See instructions below)
(FOR TTB USE ONLY)

PART I - NOTICE

2. TO 

Director, National Revenue Center / Alcohol and Tobacco Tax and Trade Bureau
550 Main St., Ste 8002
CincinnatI, OH 45202-5215

The undersigned gives notice of the shipment of wines manufactured , bottled, or packaged in the United States
on which drawback of the Internal Revenue tax paid or determined is claimed.

3. EXPORTER - NAME AND ADDRESS (Number, Street, City, State, Zip Code
4. Permit/Registry Number

DATE RECEIVED

5. EMPLOYER IDENTIFICATION NUMBER

TTB F 5620.4
FILED WITH CLAIM NO.2

6. PURPOSE
OF
SHIPMENT
(Make
applicable
entries)
7. CONSIGNED
TO OR IN
CARE OF
(Make
applicable
entries)

TRANSFER TO
SHIPMENT FOR
FOREIGN TRADE
EXPORT TO ARMED
ZONE
FORCES OF THE U.S.
EXPORTATION TO (Name of foreign port and country)

(Number)

USE AS SUPPLIES ON

AIRCRAFT3

CLAIM NUMBER

AMOUNT CLAIMED
$
AMOUNT REJECTED
$

(Location)

AMOUNT APPROVED
A VESSEL3

CLAIMS CLERK

3257DIRECTOR OF CUSTOMS AT PORT OF
TRANSPORTATION (Name) (Name)
OFFICER

CUSTOMS OFFICER IN (Number)
CHARGE OF FOREIGN
TRADE ZONE
10. DESCRIPTION OF WINE SHIPPED
KIND
OF
WINE

NUMBER
OF
PACKAGES

(a)

(b)

CASES
BOTTLES
NUMBER in case size
(c)

(d)

(e)

8. NAME OF DOMESTIC CARRIER

(Location)

9. NAME OF EXPORT CARRIER

(Location)

SERIAL NUMBERS OF
CONTAINERS OR CASES 4
(f)

ALC.
CONTENT

TOTAL
WINE
GALLONS

(g)

(h)

DRAWBACK
RATE PER WINE
GALLON
(i)

PART II - CLAIM
The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded within 11. AMOUNT CLAIMED
the limits of the United States. The kind, quantity, and description of the wines stated in Part I is correct, and I am
$
justly entitled to drawback of the tax in the amount claimed herein. Internal Revenue tax equal to such amount has been
12. I REQUEST DRAWBACK
paid or determined as provided by law and regulations. No other claim for allowance of drawback has been made under 26
ALLOWED TO BE PAID
U.S.C. 5062(b), or Section 309 of the Tariff Act of 1930, as amended, on these wines or any part thereof. Under penalties of
BY
perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the
statements herein and in Part I, are true, correct, and complete.
CREDIT
CHECK
13. DATE
14. EXPORTER
14b. TITLE
a. SIGNATURE

1
Insert, as applicable, plant number of distilled spirits plant, registry number of bonded
wine cellar or taxpaid wine bottling house, or number of the wholesale liquor dealers
permit issued under the Federal Alcohol Administration Act.
2
Complete only for consolidated claims; show serial number of last claim tabulated.
3
State whether a (a) vessel or aircraft operated by the United States; (b) vessel or aircraft
engaged in foreign trade, or in trade between the United States and any of its
possessions, or between Hawaii or Alaska and any other part of the United States;
TTB F 5120.24 (8/2006)
TTB F 5120.24 (09/2008)

Page 1 of 2

(c)
(c) vessel
vessel of
of the
the United
United States
States engaged
engaged in
in trade
trade between
between Atlantic
Atlantic
and
employed
in
and Pacific
Pacific ports
ports of
of the
the United
United States;
States; (d)
(selvessel
employed
in
country
and ports
ofthe
call,wd)
or ifveshaling
a whalingbusiness.
vessel, location
country of
(1)registry,
the fisheries:
or (2)
Sh
of
If aircraft,
show also
of show
airlinealso
andname
country
of operations.
vessel, location
of operations.
If name
aircraft,
of of
airline and
country of registry of aircraft. 4Show filing date when
registry
of aircraft.
4
Show
fillingdate
datehas
when
useauthorized
of such date
hasof
been
authorized
use
of such
been
in lieu
serial
numbers in
o
lieu of serial numbers on cases.

PART III-CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT

I hereby certify that the wines described in Part I were found as described, except as noted in Item 20, and that the wines were -VESSEL (Name)
AIRCRAFT (Name, symbols, number)
15. LADEN FOR
TRUCK (State license)
RAILROAD CAR (Number)
USE AS
SUPPLIES
ON BOARD
17. SHIPPED TO (Frontier Port)
18. SERIAL NUMBER OF SEALS USED
16. RECEIVED IN NUMBER
FOREIGN
TRADE ZONE
19. INSPECTION
I
DISCLOSED
DISCREPANCIES
NO
NO N
EVIDENCE OF
OR SHORT SHIPMENT
DISCREPANCY
T
AS FOLLOWS:
TAMPERING
22. SIGNATURE AND TITLE OF CUSTOMS OFFICER
20. DATE
21. PORT
EXPORT

PART IV - CUSTOMS OFFICER’S PORT REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
23. FRONTIER PORT

NO EVIDENCE OF TAMPERING

25.

SEALS BROKEN

26. NATURE AND EXTENT OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
27.

The exporting conveyance noted in Item 15, bearing the wines described in Item 10,
with exceptions as noted in items 20
27, cleared from this port for the port of
19 and 26,
28. DATE
29. SIGNATURE AND TITLE OF CUSTOMS OFFICER

FOREIGN PORT

PART V - CERTIFICATE OF CLEARANCE OR USE

30. THE EXPORTING CONVEYANCE BEARING THE WINES DESCRIBED IN ITEM 10, WITH EXCEPTIONS AS NOTED ABOVE -CLEARED FROM THE PORT OF

ON (Date)

BOUND FOR (Foreign port)

31. THE WINE HAS BEEN USED AS SUPPLIES ON THE

32. DATE
33. SIGNATURE OF PORT DIRECTOR OF
CUSTOMS
FISHING VESSEL OR AIRCRAFT IDENTIFIED ABOVE,
AND THE EVIDENCE OF SUCH USE HAS BEEN
RECEIVED .
PART VI - CERTIFICATE RECEIPT BY ARMED FORCES OFFICER

The wine described in Part I, with exceptions as noted in item 35, were received for export to the Armed Forces of the United States. The wines will
not be shipped for consumption or used in any place subject to the application of the Internal Revenue laws of the United States.
34. DATE
35. DISCREPANCIES
36. SIGNATURE

37. RANK

38. TITLE

INSTRUCTIONS
1. GENERAL. Under 27 CFR 28.212 and
and 28.214
28.214 persons
persons qualified
qualified as
asproprietors
proprietorsof
ofdistilled
distilled
spiritsbonded
plants, wine
bonded
wineor
cellars,
orwine
taxpaid
winehouses,
bottling or
houses,
holding liquor
spirits plants,
cellars,
taxpaid
bottling
holdingorwholesale
wholesale
liquor
dealerunder
permits
theAdministration
Federal Alcohol
Adminstration
Act,toare
dealer permits
issued
the issued
Federalunder
Alcohol
Act,
are authorized
file claims
authorized
to file claims
on Formof5120.24
forofallowance
of drawback
of Internal Revenue
on Form 5120.24
for allowance
drawback
Internal Revenue
taxes.
taxes.
2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy,
2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy,
marked “Consignee’s
“Consignee’s Copy,”
where the
marked
Copy,” where
the wine
wine is
is for
for use
use on
on an
an aircraft.
aircraft.
3. INSTRUCTIONS
INSTRUCTIONS TO
TO EXPORTER.
3.
EXPORTER. Complete
and execute
execute Part
Part II.
II. AIf proprietor
you are a may
Complete Part
Part II and
elect (in item
to recoup
approved
drawback
allowance
check
or credit.allowance
A check or ACH
proprietor
of a12)
bonded
winean
cellar,
you may
elect (item
12) to by
have
a drawback
paid
eitherpayment
by checkwill
or be
by issued
credit (TTB
2639), which
be claimed
on a subsequent
electronic
if theF"Check"
box is can
marked.
An approved
credit can be taken
tax
on Form
5000.24; on
all one
otherorclaimants
should
the(Form
box designated
On
as areturn
decreasing
adjustment
more Excise
Taxcheck
Returns
5000.24). “Check”.
On shipments
shipments
the wine,
andofone
form todesignated
the official designated in
of the wine,offorward
theforward
originalthe
andoriginal
one copy
thiscopy
form of
to this
the official
Item
7, forward
oneone
copy
to the
Director,
NRC,
Alcohol
andand
Tobacco
TaxTax
andand
Trade
Bureau
in Item
7, forward
copy
to the
Director,
NRC,
Alcohol
Tobacco
Trade
Bureau
at
in item
item 2,
2, and
and retain
retain aa copy
copy in
in your
your files.
files. IfIfaa“Consignee’s
“Consignee’sCopy”
Copy”has
has
at the
the address
address shown
shown in
been prepared (see instruction 2), forward it to the airline company at the airport.
been prepared (see instruction 2), forward it to the airline company at the airport.
4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other
4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other Than
Than Fishing Vessels. After inspection of lading, the Customs officer must execute Part IV,
Fishing Vessels.
After
inspection
lading,
the Customs
officerTax
must
execute
IV, forward
forward
the original
to the
Director,ofNRC,
Alcohol
and Tobacco
and
Trade Part
Bureau
at the
the original
to the
NRC,
Alcohol
and Tobacco
and(b)
Trade
at the
address
shown
in Director,
item 2, and
retain
the copy
for his/herTax
files.
Use Bureau
on Aircraft
andaddress
Fishing
shown
in
item
2,
and
retain
the
copy
for
his/her
files.
(b)
Use
on
Aircraft
and
Fishing
Vessels.
Vessels. After inspection of lading, the Customs officer must execute Part III on both copies
After inspection of lading, the Customs officer must execute Part III on both copies

and forward them to the Port Director of Customs. The Port Director, on receipt of the
required ”Certificates of Use” (for aircraft) or Customs Form 5125 (for fishing vessels), must
execute Part V, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade
Bureau at the address shown in item 2, and retain the copy for his/her files. (c) Lading at Interior
Port For Exportation Through Frontier Port. On completion of lading, the Customs officer
will affix the seals, then execute Part III on both copies and forward them to the Port
Director of Customs at the interior port of lading for forwarding to the Customs officer at the
frontier port. That officer, when satisfied that the shipment has been exported, must execute
Part IV on both copies and return them to the Port Director of Customs at the interior port.
The Port Director will then execute Part V, forward the original to the Director, NRC,
Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the
copy for his/her files. (d) Receipt in Foreign Trade Zones. On receipt of the wine, the Customs
officer must execute Part III on both copies, forward the original to the Director, NRC,
Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the
copy for his/her files.
5. ACTION BY ARMED FORCES OFFICER. On receipt of the wines, the officer to whom
consigned (or other authorized supply officer) must execute Part VI on both copies, forward
the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address
shown in item 2, and retain the copy for his/her records.

RETENTION PERIOD: The retention period is three years from the record date or the date
of the last entry required to be made on the record, whichever is later. The appropriate
TTB officer may require records to be kept an additional period not to exceed three years.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with Paperwork Reduction Act of 1995. This information collection is used to obtain drawback of taxes on wine exported from the United States. The
information is required to obtain a benefit under 26 U.S.C. 5062. PAPERWORK REDUCTION ACT NOTICE
This
request is in
accordance
with
Paperwork
Reduction
Act of of
1995.
This information
is used
obtain drawback
of taxes on wine
exported
the United
States. The
The estimated
average
burden
associated
with
this collection
information
is 1 hour collection
and 7 minutes
pertorespondent
or recordkeeper,
depending
on from
individual
circumstances.
information
required tothe
obtain
a benefit
under
26 U.S.C.
5062.
Comments is
concerning
accuracy
of this
burden
estimate
and suggestions for reducing this burden should be addressed to the Report Management Officer, Regulations and
Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
The estimated average burden associated with this collection of information is 1 hour and 7 minutes per respondent or recordkeeper, depending on individual circumstances. Comments
An agency may
not conduct
or burden
sponsor,
and a person
is not required
to respond
to, a collection
of information
it displays
a current,
valid OMB
control and
number.
concerning
the accuracy
of this
estimate
and suggestions
for reducing
this burden
should be
addressed tounless
the Report
Management
Officer,
Regulations
Rulings Division,
Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
TTB F 5120.24 (7/2006)
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 5120.24 (09/2008)

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