Form TTB F 5100.24 TTB F 5100.24 Application for Basic Permit under the Federal Alcohol A

OMB NO. 1513-0018 (07/31/2008)

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

APPLICATION FOR BASIC PERMIT UNDER THE FEDERAL ALCOHOL ADMINISTRATION ACT
1.

FULL NAME AND PREMISES ADDRESS

TELEPHONE NUMBER (
)
State in which organized for Corporations and Limited Liability Companies (LLC):
2. MAILING ADDRESS (If different from premises address)

6.

3.

EMPLOYER IDENTIFICATION NUMBER (EIN)
(Social Security number is not acceptable)

4.

OPERATING NAME (DBA), if any

5.

LABELING TRADE NAME(S), if any

BUSINESS(ES) TO BE CONDUCTED AT PREMISES ADDRESS (Check applicable boxes)
a.

DISTILLED SPIRITS PLANT (BEVERAGE)
DISTILLING
WAREHOUSING AND BOTTLING DISTILLED SPIRITS
PROCESSING (RECTIFYING) DISTILLED SPIRITS AND WINE

c.

IMPORTING INTO THE UNITED STATES
DISTILLED SPIRITS
WINE
MALT BEVERAGES

b.

BONDED WINE PREMISES
PRODUCING AND BLENDING WINE
BLENDING WINE

d.

PURCHASING FOR RESALE AT WHOLESALE
DISTILLED SPIRITS
WINE
MALT BEVERAGES

or while so engaged, sell, offer, or deliver for sale, contract to sell, or ship in interstate or foreign commerce the alcoholic beverages so distilled,
produced, rectified, blended or bottled, warehoused and bottled, imported, or purchased for resale at wholesale.
7.

REASON FOR THE APPLICATION (use date format MM/DD/YYYY)
a.
NEW BUSINESS
Anticipated start date ___________

b.

8.

c.

CHANGE IN OWNERSHIP
Date of Change _______________
Name, address, and permit number(s) of predecessor

CHANGE IN CONTROL (Actual or legal)
Submit Basic Permit(s) with this application.
Date of Change ______________

OWNER INFORMATION (List sole owner, all general parties, LLC members/managers, corporate officers and directors, and shareholders with more
than 10% voting stock. Each listed person must also furnish the information in Item 9.)
NAME
NAME

TITLE
TITLE

% VOTING/STOCK/INTEREST

% VOTING/STOCK/INTEREST
(If applicable)
(If applicable)

INVESTMENT IN
INVESTMENT IN
BUSINESS (Item 6)

BUSINESS (Item 6)

SOURCE OF FUNDS INVESTED
(savings,
gift, or
specify
SOURCEloans,
OF FUND,S
INVESTED
& financial
other
(savings,
loans, giftinstitution
or specify other)
name, city & state)

IF APPLICANT IS ACTUALLY OR LEGALLY CONTROLLED BY PERSONS OR BUSINESSES NOT IDENTIFIED ABOVE, PROVIDE ON A SEPARATE
SHEET INFORMATION (as specified for Item 9) FOR EACH PERSON OR BUSINESS AND STATE THE EXTENT AND MANNER OF THE CONTROL.
BUSINESSES SHOULD INCLUDE THEIR EIN.
9. COMPLETE FOR EACH PERSON LISTED IN ITEM 8.
a. FULL GIVEN NAME
b. DATE AND PLACE OF
c. SOCIAL SECURITY OR EMPLOYER
d. ARE YOU A U.S. CITIZEN?
BIRTH
IDENTIFICATION NUMBER
YES
NO
e.

f. OTHER NAMES USED (Maiden name, nicknames, etc.)
MALE

FEMALE

g. RESIDENCE(S) OVER THE LAST FIVE YEARS

TTB F 5100.24 (02/2008)

Page 1 of 2

a. FULL GIVEN NAME

b. DATE AND PLACE OF
BIRTH

c. SOCIAL SECURITY OR EMPLOYER
IDENTIFICATION NUMBER

d. ARE YOU A U.S. CITIZEN?
YES

e.

NO

f. OTHER NAMES USED (Maiden name, nicknames, etc.)
MALE

FEMALE

g. RESIDENCE(S) OVER THE LAST FIVE YEARS

a. FULL GIVEN NAME

b. DATE AND PLACE OF
BIRTH

c. SOCIAL SECURITY OR EMPLOYER
IDENTIFICATION NUMBER

d. ARE YOU A U.S. CITIZEN?
YES

e.

NO

f. OTHER NAMES USED (Maiden name, nicknames, etc.)
MALE

FEMALE

g. RESIDENCE(S) OVER THE LAST FIVE YEARS

b. DATE AND PLACE OF
BIRTH

a. FULL GIVEN NAME

c. SOCIAL SECURITY OR EMPLOYER
IDENTIFICATION NUMBER

d. ARE YOU A U.S. CITIZEN?
YES

e.

NO

f. OTHER NAMES USED (Maiden name, nicknames, etc.)
MALE

FEMALE

g. RESIDENCE(S) OVER THE LAST FIVE YEARS

a. FULL GIVEN NAME

b. DATE AND PLACE OF
BIRTH

c. SOCIAL SECURITY OR EMPLOYER
IDENTIFICATION NUMBER

d. ARE YOU A U.S. CITIZEN?
YES

e.

NO

f. OTHER NAMES USED (Maiden name, nicknames, etc.)
MALE

FEMALE

g. RESIDENCE(S) OVER THE LAST FIVE YEARS

10. HAS THE APPLICANT OR ANY PERSON LISTED FOR ITEMS 8 OR 9 EVER BEEN DENIED A PERMIT, LICENSE, OR OTHER AUTHORIZATION
TO ENGAGE IN ANY BUSINESS TO MANUFACTURE, DISTRIBUTE, IMPORT, SELL, OR USE ALCOHOL PRODUCTS (beverage or nonbeverage)
BY ANY GOVERNMENT AGENCY (Federal, State, local, or foreign) OR HAD SUCH PERMIT, LICENSE, OR OTHER AUTHORIZATION REVOKED,
SUSPENDED, OR OTHERWISE TERMINATED?
YES. State details of each event on a separate sheet.

NO

11. HAS THE APPLICANT OR ANY PERSON LISTED FOR ITEMS 8 OR 9 EVER BEEN ARRESTED FOR, CHARGED WITH, OR CONVICTED OF ANY
CRIME UNDER FEDERAL, STATE, OR FOREIGN LAWS other than traffic violations or convictions that are not felonies under Federal or State law.
YES. State details of each event on a separate sheet.

NO

TTB MAY REQUIRE additional information to process this application. If you are applying for a basic permit to operate a distilled spirits plant or
bonded wine premises, you must also file additional forms and information required under the Internal Revenue Code. OPERATION WITHOUT A
PERMIT. Criminal and administrative actions may be taken against persons engaged in a business listed in Item 6 of this form if it is not conducted
pursuant to an FAA Act basic permit.
APPLICANT'S AFFIRMATION. Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and
to the best of my knowledge and belief, it is true, correct, and complete. The applicant must immediately notify the TTB official with whom this application is filed of any change in ownership, management, or control of the applicant (in the case of a corporation, any change in the officers, directors, or
persons holding 10 percent or more of the corporate stock). The business for which this application is made does not violate the law of the State in
which the business will be conducted. In addition, if this application is approved, the applicant will conduct operations within a reasonable period of
time and maintain such operations in conformity with Federal law.
12. APPLICANT'S SIGNATURE (Sole owner, partner, corporate
officer, LLC member or manager, or if designated agent, submit
TTB F 5000.8)

13. TITLE OF PERSON SIGNING

14. DATE

15. E-MAIL (INTERNET) ADDRESS (optional):

TTB F 5100.24 (02/2008)

Page 2 of 2

INSTRUCTIONS
1.

GENERAL. You must file this application if you want a permit under
the Federal Alcohol Administration Act (FAA Act) to engage in the
business of:
· Producing or processing distilled spirits or wine includes for
nonindustrial use.
· Importing into the United States, or wholesaling, alcoholic
beverages.

PUERTO RICO

Ste 310 Torre Chardon, 350
787-766-5584
Carlos Chardon Ave, San Juan, PR 00918 -21244
San Juan, PR 00918 -21244
550 Main Street, Suite 8002
1-877-882-3277
Cincinnati, OH 45202

3.

LABEL APPROVALS FOR BOTTLED ALCOHOLIC BEVERAGES.
Bottlers, packagers, and importers should have TTB approved label
certificates (TTB F 5100.31). A label approval is required to sell,
ship, or deliver for sale or shipment, or to otherwise introduce in
interstate or foreign commerce, alcoholic beverages. Also, a label
approval allows importers to release specific imported alcoholic
beverages from Customs' custody. For label approvals contact TTB,
Advertising, Labeling and Formulation Division, Washington, DC
20220, (202-927-8140). TTB does not approve certificates until
you have the appropriate FAA Act basic permit. You can submit
draft labels (for example, mockups) to TTB for review before printing
the labels. Trade name approval on your FAA Act basic permit does
not constitute approval as a brand name for labeling purposes.

4.

SPECIAL TAX. If you operate a distilled spirits plant or bonded
wine premises or deal in beer, wine, or distilled spirits, file
TTB F 5630.5, Special Tax Registration and Return, and pay an
annual tax. File TTB F 5630.5 and pay this tax when you start
selling, or offer for sale, alcoholic beverages. You do not file this
form or pay special tax when your business only involves the
importation or sale of fermented cereal beverages which have an
alcoholic content of less than 1/2 percent or where your business
is only in Puerto Rico.

5.

EMPLOYER IDENTIFICATION NUMBER. You need to have this
number for your business even if you do not have any employees.
To obtain an EIN, file Form SS-4 with the Internal Revenue Service.

COMPLETING AND FILING THIS APPLICATION.
· Please type or print and complete all items.
· Write "not applicable" in any item requesting information that does
not apply to your business.
· Items 8 through 11: If this information is on file with TTB, state
“On file under (name and TTB permit or registry number or type of
pending application) ."
· If you need additional room, use a separate sheet.
· If your producing or processing operations will be in Puerto Rico,
contact the Director, Puerto Rico Operations, for additional
requirements.
· Send this form in duplicate to the appropriate TTB (Alcohol and
Tobacco Tax and Trade Bureau ) office.

Send to:
TTB

ALL OTHER STATES

Nonindustrial use of distilled spirits or wines includes all beverage
purposes or uses in preparing foods or drinks. Wholesaling under
the FAA Act means purchasing alcoholic beverages for resale at
wholesale. The FAA Act defines alcoholic beverages as distilled
spirits, wine, or malt beverages including any fermented cereal
beverages which have an alcohol content of not less than 1/2 percent.
2.

Location of
Business

PRIVACY ACT INFORMATION
1. AUTHORITY. Solicitation of information on TTB F 5100.24 is made pursuant to 27 U.S.C. Section 204(c). Disclosure of this information by the
applicant is mandatory if the applicant wishes to obtain a basic permit under the Federal Alcohol Administration Act.
2. PURPOSES. To identify the applicant, the location of the premises, and to determine the eligibility of the applicant to obtain a basic permit.
3. ROUTINE USES. The information will be used by TTB to make deteminations set forth in paragraph 2 above. Where such disclosure is not
prohibited, TTB officers may disclose this information to other Federal, State, foreign, and local law enforcement and regulatory agency personnel
to verify information on the application, and for enforcement of the laws of such other agency. The information may be disclosed to the Justice
Department if the application appears to be false or misleading. TTB officers may disclose the information to individuals to verify information on
the application where such disclosure is not prohibited.
4. EFFECTS OF NOT SUPPLYING INFORMATION REQUESTED. TTB may delay or deny the issuance of the FAA Act basic permit where
information is not complete or missing.
5. DISCLOSURE OF EMPLOYER IDENTIFICATION NUMBER AND SOCIAL SECURITY NUMBER. You do not have to supply these numbers.
These numbers are used to identify an individual or business. If you do not supply the numbers, your application may be delayed.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction of 1995. The information collection is used to determine the eligibility of the applicant
to engage in certain operations, to determine the location and extent of operations, and to determine whether the operations will be in conformity
with Federal laws and regulations. The information requested is required to obtain or retain a benefit and is mandatory by statute (27 U.S.C. 203
and 204 (c)).
The estimated average burden associated with this collection of information is 1 hour and 45 minutes per respondent depending on individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed 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.
TTB F 5100.24 (02/2008)