Form TTB F 5200.7 TTB F 5200.7 Schedule of Tobacco Products, Cigarette Papers or Tubes

OMB No. 1513-0034 (06/30/2011)
1. SERIAL NUMBER
(Begin with “1” January
1 each year)

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

SCHEDULE OF TOBACCO PRODUCTS, CIGARETTE PAPERS OR TUBES
WITHDRAWN FROM THE MARKET
(See Instructions Below)
REQUEST FOR DISPOSITION AUTHORIZATION

Operation is desired, as indicated, of the cigars, cigarettes, chewing tobacco, snuff, pipe tobacco, roll-your-own tobacco, cigarette papers, and
cigarette tubes described below, withdrawn from the market after removal from factory or customs custody.
2.

NAME AND MAILING ADDRESS OF TAXPAYER (Number and street or P.O. Box, city, State and ZIP Code) 5.
2a. EIN (Employer Identification Number)

2b. PERMIT NUMBER
3.

LOCATION WHERE ARTICLES ARE ASSEMBLED (Number and street, city and State)

6.

These articles taxed under 26 U.S.C.
5701 (Produced in U.S.A. or a foreign
country)
or
These articles taxed under 26 U.S.C.
7652(a) (Produced in Puerto Rico)
or
These articles taxed under 26 U.S.C.
7652(b) (Brought in from U.S.Virgin
Islands)
Tax has been paid on articles listed hereon
or

4.

IDENTITY OF FACTORY OR FACTORIES FROM WHICH ARTICLES WERE REMOVED

4a. PERMIT NUMBER
7.

DISPOSITION TO BE MADE OF ARTICLES (Select only one)
RETURNED TO BOND

TO BE DESTROYED

IMPORTED ARTICLES TO NON-TAXPAID STATUS,

Tax has not been paid on articles listed
hereon but such tax was determined on
in accordance
with the provisions of applicable
regulations.
8. DATE DISPOSITION DESIRED

REDUCED TO MATERIALS

7a. PERMIT NUMBER OF FACTORY RECEIVING ARTICLES

KIND OF ARTICLES
SALE
(small cigarettes, large cigars, NUMBEROF PRICE PER
chewing tobacco, snuff, etc.) CONTAINERS
M1
(a)
(b)
(c)

9. DESCRIPTION OF ARTICLES
NUMBEROF
TOTAL SALE PRICE2
LBS./OZ.IN
TOTAL
NUMBER
OF
(col. (c) x col.
EACH
POUNDS/OUNCES
(e) ÷ 1000)
CONTAINER
(e)
(f)
(d)

RATE OF
TAX
(g)

AMOUNT OF
TAX
(h)

10. TOTAL $
1

FOOTNOTES: Complete only for large cigars. Enter the taxable sale price per thousand. (See instructions.)
2
Complete only for large cigars with a sale price of not more than $763.222 per thousand.
THIS FORM IS NOT A CLAIM and its submission does not affect the statutory period of limitations for filing claims. Claim must be filed by separate
document on TTB F 5620.8 within the period prescribed by law. See instruction (4.) on reverse.
11. SIGNATURE AND TITLE OF TAXPAYER (This schedule must be signed by the individual owner, member of firm, officer
of corporation, or other person duly authorized by the taxpayer to sign.)
TTB F 5200.7 (0/20)

12. DATE OF SCHEDULE

DISPOSITION AUTHORIZATION
The taxpayer is authorized to dispose of the articles listed hereon, in the manner indicated, without TTB supervision.
SIGNATURE OF TTB OFFICER

DISPOSITION

DISPOSITION OF ARTICLES
QUANTITY
(Kind of article)
(Kind of article)

DATE

(Kind of article)

(Kind of article)

13. RECEIVED INTO FACTORY
(Show permit No.)
14. REDUCED TO MATERIALS
15. DESTROYED BY (Show method)
16. TOTAL
TTB OFFICER’S CERTIFICATE: I have inspected the articles and find that they are correctly described in this schedule, except as indicated
below, and have supervised their disposition as shown under “Disposition of Articles.” (If no exceptions, so indictate below.)
EXCEPTIONS:
SIGNATURE AND TITLE OF TTB OFFICER

DATE

CERTIFICATE OF DISPOSITION BY TAXPAYER: Under the penalties of perjury, I declare that this schedule is true and correct and that the
articles listed on it were disposed of as shown under “Disposition of Articles.”
SIGNATURE AND TITLE OF TAXPAYER (This certificate must be signed by the individual owner, member of firm, officer of corporation, or other
person authorized by the taxpayer to sign.)

DATE

INSTRUCTIONS
1. ASSEMBLY OF ARTICLES - Prior to submitting this schedule to the
National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau
for disposition authorization, the taxpayer assembles the articles
according to the applicable rate of tax, (1) in or adjacent to a factory if
the articles are to be returned to bond, or (2) at any suitable place if the
aricles are to be destroyed or reduced to materials.

2. PREPARATION
PREPARATIONOF
OFSCHEDULE
SCHEDULE
- This
schedule
is prepared
taxpayer in
- This
schedule
is prepared
by by
thethe
taxpayer
triplicate
In block
block7,
7,whether
whetherthe
thearticles
articles are
in
triplicatetotoshow
showthe
thefollowing
following information:
information: In
are
to destroyed
be destroyed
or returned
bond,
thecase
caseof
ofimported
imported articles,
to be
or returned
toto
bond
(or,orininthe
articles,to
to a
anontaxpaid
non-taxpaidstatus)
status,or
orare
aretotobe
bereduced
reduced to
tomaterials,
materials. and
In block
7a. thenumber of
the permit
permit
number
of the factory
receivingInsuch
articles.
In blocknumber
4, the location
the factory
receiving
such articles.
block
4, the permit
or location of
and
block or
4a,factories
the permit
number,
thearticles
factorywere
or factories
fromor,
which
the in
factory
from
whichofthe
removed
in thethe
case of
articles
were
the taxthe
was
paid. In
9: In
columnof(a),
each kind
of articles
imported
articles,
location
ofblock
the port
director
customs
or identity
of other
such
small the
cigarettes,
cigarettes,
cigars, large
cigars,
chewing
officeaswhere
tax waslarge
paid.
In block small
9: In column
(a), each
kind
of articles
tobacco,
tobacco,
roll-your-own
cigarette
papers,
orchewing
such as snuff,
small pipe
cigarettes,
large
cigarettes,tobacco,
small cigars,
large
cigars,
cigarette
In column
(b), roll-your-own
number of containers
(packages)
of cigars,or
tobacco,tubes.
snuff, pipe
tobacco,
tobacco,
cigarette papers,
cigarettes,
chewing
snuff,
pipe tobacco,
roll-you-own
tobacco,
cigarette tubes.
In tobacco,
column (b),
number
of containers
(packages)
of cigars,
cigarette
tubes
or cigarette
papers.
column
(c), the
sale price per
thousand
cigarettes,
chewing
tobacco,
snuff,Inpipe
tobacco,
roll-you-own
tobacco,
cigarette
of
largeorcigars.
Show
eitherIn
the
taxable(c),
sale
supported
by records,
or
tubes
cigarette
papers.
column
theprice
saleas
price
per thousand
of large
else
the lowest
sale price
applicable
to price
that brand
and size by
of cigars
shown
on
cigars.
Show either
the taxable
sale
as supported
records,
or else
the manufacturer’s basic record of sale prices during the period that this
the lowest sale price applicable to that brand and size of cigars shown on the
record is required to be retained. In column (d), the number or weight of the
manufacturer’s basic record of sale prices during the period that this record is
article in each container. In column (e), the total number or weight of cigars,
required to be retained. In column (d), the number or weight of the article in each
cigarettes, chewing tobacco, snuff, roll-your-own tobacco, pipe tobacco,
container. In column (e), the total number or weight of cigars, cigarettes, cUhewing
cigarette tubes, or cigarette papers. In column (f), the total sale price only of
tobacco, snuff, roll-you-own tobacco, pipe tobacco, cigarette tubes, or cigarette
large cigars with a sale price of not more than $763.222 per thousand. In
papers. In column (f), the total sale price only of large cigars with a sale price of
column (g), the rate of tax applicable to that article. In column (h), the
not more than $235.294 per thousand. In column (g), the rate of tax
respective amount of tax.
applicable to that article. In column (h), the respective amount of tax.

3. REQUEST FOR DISPOSITION - When the articles are assembled and
this schedule is prepared, the taxpayer (or his authorized representative)
executes the form in block 11 and forwards all three copies to the
Director, National Revenue Center, Alcohol and Tobacco Tax and Trade
Bureau. The National Revenue Center will either assign a TTB officer to
verify the schedule and supervise disposition of the articles or authorize
the taxpayer to dispose of the articles without supervision by executing
the disposition authorization on two copies of the schedule returned to
the taxpayer. Where a TTB officer is assigned, he/she, upon completion
of his inspection, returns to the taxpayer two verified copies of the
schedule where claim for credit or refund is to be made and one
verified copy where claim for allowance is to be made. Where the
Alcohol and Tobacco Tax and Trade Bureau authorized the taxpayer to
dispose of the articles without supervision, the taxpayer (or his/her
authorized representative), upon completion of the disposition executes
the taxpayer’s certificate of disposition on both copies of the schedule.
4. MANNER OF FILING CLAIM - The original of this schedule, after the proper
certificate has been executed, may be used to support a claim on
TTB F 5620.8. The duplicate of the schedule is, in any case,
retained by the taxpayer. Where claim is made, TTB F 5620.8 is
filed by the taxpayer with the:
Director, National Revenue Center, TTB
550 Main St, Ste 8002
Cincinnati, Ohio 45202-5215

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to support claims for tax credit or refund on
tobacco products to be withdrawn from the market. The information is mandatory by statute (26 U.S.C. 5705).
The estimate average burden associated with this collection of information is 45 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, D.C. 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 5200.7 (0/20)