Form TTB F 5120.17 TTB F 5120.17 Report of Wine Premises Operations

OMB No. 1513-0053 (10/31/2011)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT OF WINE PREMISES OPERATIONS
OPERATED BY (Name, Address, and Telephone)

PERIOD COVERED (Year Only, or Year & Month, or Year & Quarter)
YEAR

MONTH

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48$57(5/<

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January to March

July to September

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April to June _______________
October
to December_________________________________________________________________________________________________________
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VERSION (Select Original or Amended. Select Final also if last report for the business) EIN
REGISTRY NUMBER
Original
Amended
Final Report
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INSTRUCTIONS
1. The reporting period for this form must be monthly, except that proprietors who qualify under
the exception stated in 27 CFR 24.300(g)(2) may file this form on a TXDUWHUO\RUcalendar year
EDVLVXQOHVVrequired to file monthly by the Alcohol and Tobacco Tax and Trade Bureau (TTB).
$SURSULHWRUwho files monthly reports but does not expect any reportable operations in a
VXEVHTXHQWPRQWKor months may indicate in Part X that no monthly reports will be filed until a
UHSRUWDEOHRSHUDWLRQoccurs (§ 24.300(g)(1)).
2. Prepare this form in duplicate and file it by the fifteenth day after the end of the report period
( PRQWKTXDUWHUor year). Keep the copy on your bonded wine premises for inspection by TTB
RIILFHUVSend the original to TTB at this address:'LUHFWRU1DWLRQDO5HYHQXH&HQWHU$OFRKRODQG
Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215.

3. Explain any unusual operations in Part X.
4. The quantities "on hand end" will ordinarily be "book inventory" figures, that is the quantity
required to balance each summary. Use the "on hand end" from your report for the previous period
as the "on hand beginning" of the current report. On reports for any period when you take a
physical inventory, report the difference as losses for bulk wine and shortages for bottled wine, or as
gains, as the case may be.
5. If the quantity of wine previously reported on TTB F 5120.17 is affected by adjustments made on
a tax return, TTB F 5000.24, adjust the current TTB F 5120.17 in Section A (and Section B, if
bottled wine is involved). Explain the entries in Part X.

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PART I - SUMMARY OF WINES IN BOND (GALLONS)

ALCOHOL CONTENT BY VOLUME
NOT OVER 14
PERCENT
(a)

ITEM

1.

SECTION A - BULK WINES
ON HAND BEGINNING OF PERIOD

2.

PRODUCED BY FERMENTATION1/

3.

PRODUCED BY SWEETENING

4.
5.
6.

PRODUCED BY ADDITION OF WINE SPIRITS
PRODUCED BY BLENDING
PRODUCED BY AMELIORATION

7.
8.
9.

RECEIVED IN BOND
BOTTLED WINE DUMPED TO BULK
INVENTORY GAINS

OVER 14 TO 21 PERCENT OVER 21 TO 24 PERCENT
(Inclusive)
(Inclusive)
(b)
(c)

ARTIFICIALLY
CARBONATED
WINE
(d)

SPARKLING WINE
(e)

HARD CIDER
(f)

BF
BP

10.
11.
TOTAL

12.

BF
BP

13. BOTTLED2/
14. REMOVED TAXPAID
15.
16.
17.
18.

TRANSFERS IN BOND
REMOVED FOR DISTILLING MATERIAL
REMOVED TO VINEGAR PLANT
USED FOR SWEETENING

19. USED FOR ADDITION OF WINE SPIRITS
20. USED FOR BLENDING4/
21. USED FOR AMELIORATION
22. USED FOR EFFERVESCENT WINE
23. USED FOR TESTING
24.
25.
26.
27.
28.
29. LOSSES (OTHER THAN INVENTORY)
30. INVENTORY LOSSES
31. ON HAND END OF PERIOD
TOTAL

32.
1.
2.

SECTION B - BOTTLED WINES
ON HAND BEGINNING OF PERIOD
BOTTLED2/

BF
BP

3.
4.
5.
6.

RECEIVED IN BOND
TAXPAID WINE RETURNED TO BOND

TOTAL

7.
8.

REMOVED TAXPAID

9.
10.
11.
12.

TRANSFERRED IN BOND
DUMPED TO BULK
USED FOR TASTING
REMOVED FOR EXPORT

13. REMOVED FOR FAMILY USE
14. USED FOR TESTING
15.
16.
17.
18. BREAKAGE
19. INVENTORY SHORTAGE3/
20. ON HAND END OF PERIOD
21.

TOTAL

TTB F 5120.17 (0/201)
1/

Enter in col. (e) on line marked "BF" the quantity of sparNling wine produced by fermentation in bottles, and on line marked "BP" the quantity of sparNling wine produced by bulk process.

2/

Section A line 13 and Section B line 2 should shoZ the same quantities. Enter in col. (e) on line marked "BF" the quantity of finished bottle fermented sparkling wine bottled, and on line marNed "BP" the quantity of finished bXlk process wine
bottled.

3/

Fully explain in either Part X, or on a sepaUDte signed statement submitted with this report. Failure to satisfactorily explain shortages of bottled wine ma\ result in the assessment of taxHs applicable to those shortages.

4/

Only report blending if wines of diffHrent tax classes are bOended together.

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PART II - (RESERVED)
PART III - SUMMARY OF DISTILLED SPIRITS (Pr oof Gallons)
WINE SPIRITS
FOR ADDITION TO WINE5/

ITEM

1.

ON HAND BEGINNING OF PERIOD

2.
3.
4.

RECEIVED
INVENTORY GAIN

GRAPE
(a)

(b)

(c)

(d)

DISTILLATES CONTAINING
ALDEHYDES5/
FOR PREPARATION
OF DOSAGES OR
ESSENCES
(g)
(f)
(e)

SPIRITS FOR
USE IN NON
BEVERAGE
WINES

(h)

TOTAL

5. USED
6. TRANS. TO COL. (e)
7.
8. LOSSES
9. ON HAND END OF PERIOD
TOTAL

10.

PART IV - SUMMARY OF MATERIALS RECEIVED AND USED
GRAPE MATERIAL
KINDS OF MATERIALS OTHER THAN GRAPE5/
(Pounds or Gallons)
GRAPES
ITEM

UNCRUSHED FIELD CRUSHED
(Pounds)
(Gallons)
(a)
(b)

1.
2.

ON HAND BEGINNING OF PERIOD
RECEIVED

3.
4.

JUICE OR CONCENTRATE PRODUCED

5.
6.

USED IN WINE PRODUCTION
USED IN JUICE OR CONCENTRATE PRODUCTION

JUICE
(Gallons)
(c)

CONCENTRATE
(Gallons)
(d)

(e)

(f)

(g)

SUGAR
LIQUID
(Gallons)
(i)

DRY
(Pounds)
(h)

TOTAL

7. USED IN ALLIED PRODUCTS
8. REMOVED
9. ON HAND END OF PERIOD
10.

TOTAL
PART V - (RESERVED)
PART VI - SUMMARY OF DISTILLING MATERIAL AND VINEGAR STOCK (Gallons) 5/
DISTILLING MATERIAL6/

ITEM

(a)

(b)

VINEGAR STOCK

(c)

(d)

1. ON HAND BEGINNING OF PERIOD (Storage Tanks)
2. PRODUCED
3. RECEIVED FROM OTHER BONDED WINE PREMISES
4.
TOTAL

5.
6.
7.
8.
9.
10.

REMOVED TO DISTILLED SPIRITS PLANTS
REMOVED TO OTHER BONDED WINE PREMISES
REMOVED TO VINEGAR PLANTS
ON HAND END OF PERIOD (Storage Tanks)
TOTAL

11.

PART VII - IN FERMENTERS END OF PERIOD (Gallons) 5/
ITEM
1.

(a)

(b)

(c)

(d)

(e)

TOTAL

IN FERMENTERS (ESTIMATED QUANTITY OF LIQUID)
PART VIII - SUMMARY OF NONBEVERAGE WINES (Gallons)
NOT OVER 14 PERCENT ALCOHOL
(a)

ITEM
1.
2.

OVER 14 TO 21 PERCENT ALCOHOL
(Inclusive)
(b)

TOTAL
(c)

PRODUCED
WITHDRAWN
PART IX - SPECIAL NATURAL WINES AND 27 CFR 24.218 WINES (Gallons)
OTHER SPECIAL NATURAL WINES
ITEMS

1.

PRODUCED

2.
3.

TAXABLE REMOVALS
ON HAND END OF PERIOD

VERMOUTH
(a)

NOT OVER 14
OVER 14 TO 21
PERCENT ALCOHOL PERCENT ALCOHOL
(b)
(c)

ARTIFICIALLY
CARBONATED
(d)

SPARKLING
(e)

TOTAL
(cols. a, b, c, d and e)
(f)

27 CFR
24.218 WINES
(g)

PART X - REMARKS

Under penalties of perjuryI decOare that I haYe examined this report, incOuding the documents submitted in supporW thereof and to the best of m\ knoZledge and belief, it is true correct, and complete.
PROPRIETOR

5/
6/

BY (Signature and Title)

DATE

State kind - apple, blackberry, etc.
Distilling material includes lees, filter wash, and other residues used fRr production of wine spirits. See 27 CFR 24.306.

PAPERWORK REDUCTION ACT NOTICE
This information collection request is in accordance with the P aperwork Reduction Act of 1995. The purpose of this information collection is for the protection of Federal Excise taxes. The information will be
used to determine compliance by payment on untaxpaid commodities. The information required is mandator y by statute (26 U.S.C. 5367).
The estimated average burden associated with this collection of i nformation is 1 hour and 6 minutes per respondent or recordkeeper, depending on individual circumstances . Comments concer ning 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.

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TTB F 5120.17 (0/20)