Form TTB F 5170.7 TTB F 5170.7 Application and Permit to Ship Liquours and Articles of

OMB No. 1513-0008 (02/29/2012)
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

1. SERIAL NUMBER

APPLICATION AND PERMIT TO SHIP LIQUORS AND ARTICLES OF PUERTO RICAN
MANUFACTURE TAXPAID TO THE UNITED STATES
PART I - APPLICATION

2. To The Secretary of the Treasury of Puerto Rico
3. Application is made to ship the following liquors or articles of Puerto Rican manufacture to the United States in
(Check one)

bottles and cases

packages
4. DESCRIPTION OF LIQUORS OR ARTICLES

SERIAL NOS.
OF PACKAGES

(a)

5. FORMULA
(If any)

KIND OF
LIQUOR OR
ARTICLE

BRAND NAME

NO. OF
CASES
OR
PKGS

(b)

(c)

(d)

6. FORM NUMBER

SIZE OF NO. OF
BOTTLES BOTTLES
PER
CASE

(e)

(f)

CONTENTS
WINE

PROOF

PROOF
GALS.

RATE
OF
I.R.
TAX

AMOUNT OF
TAX

(g)

(h)

(i)

(j)

(k)

8. DATE APPROVED

7. SERIAL NUMBER (If any)

9. TO BE SHIPPED BY (Name of vessel)

10. TO (Port of arrival in U.S.)

11. NAME OF CONSIGNEE

12. ADDRESS OF CONSIGNEE

Under the penalties of perjury, I declare that the taxes equal to the Internal Revenue taxes imposed on like liquors and articles in the United
States have been paid or deferred on such liquors or articles, as prescribed by regulations in 27 CFR Part 26, and that this application and the
statements therein have been examined by me and, to the best of my knowledge and belief, are true, correct, and complete.
13. DATE

14. APPLICANT

15. By (Signature and Capacity)

PART II - CERTIFICATE OF INTERNAL REVENUE AGENT
To The Secretary of the Treasury of Puerto Rico
I hereby certify that taxes equal to the Internal Revenue taxes imposed on like liquors or articles in the United States have been paid or deferred
on the liquors or articles described in Part I, as prescribed by regulations in 27 CFR Part 26.
16. DATE

17. REVENUE AGENT

PART III - PERMIT TO SHIP
Permit is hereby granted to the applicant designated in Item 8 to ship to the United States the liquors or articles described in Part I.
18. DATE

19. SECRETARY

20. BY

PART IV — CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION IN PUERTO RICO
I hereby certify that, except as noted in Item 15, the liquors or articles described in Part I were duly inspected and laden for shipment to the
United States.
21. NAME OF VESSEL

22. BOUND FOR PORT OF

23. EXCEPTIONS
TTB FORM 5170.7 (01/2011)

24. DATE

25. CUSTOMS AND BORDER PROTECTION OFFICER 26. AREA PORT DIRECTOR

PART V - CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION AT PORT OF ARRIVAL IN
UNITED STATES
I hereby certify that the liquors or articles described in Part I were received and have been inspected and released as follows:
27. DATE

28. PORT OF

29. QUANTITY INSPECTED AND RELEASED

31. Identify separately the quantity lost from each container and the serial number of each container.
(a) CONTAINER SERIAL NUMBER

(b) QUANTITY LOST

1

30. Lost by breakage or otherwise
during transportation to the United
States.

32. TOTAL QUANTITY LOST

1

33. CUSTOMS AND BORDER PROTECTION OFFICER

1

34. AREA PORT DIRECTOR

Identify, as applicable, in terms of "proof gallons" (spirits), "wine gallons" (wine), or "barrels" (beer)

1. GENERAL. The shipper must prepare this form in sextuplet for each
consignment. A separate TTB F 5170.7 is required for each product
covered by an approved formula. Forms must be serially numbered
beginning with "1" each calendar year, and running consecutively
thereafter to the end of the year. The serial number must be prefixed
by the last two digits of the calendar year, e.g., 07-1."
2. PART I. The shipper must prepare Part I. Where the shipment
covers wine, enter the tax class of the wine in column 2(h) and
disregard column 2(i). Where the shipment covers beer, modify the
heading of column 2(g) to read "barrels" and enter quantity in barrels;
disregard columns 2(h) and 2(i). After executing his/her application in
Part I, the shipper must deliver all copies of the form to the Internal
Revenue Agent.
3. PART II. After executing his/her certificate in Part ll, the Internal
Revenue Agent must forward all copies of the form to The Secretary of
the Treasury of Puerto Rico.
4. PART III. After executing his/her permit to ship on all copies of the
form, the Secretary must retain one copy, send the original and two
copies to the Area Port Director in Puerto Rico, and return two copies
to the shipper.

The shipper must then submit the two copies to the Area Port
Director in Puerto Rico at least six hours prior to the intended lading
of the merchandise.
5. PART IV. The Area Port Director in Puerto Rico, on release of the
merchandise for shipment, must execute his/her certificate in Part IV
on all copies, retain one copy for his/her files, mail the original to the
Director of Customs at the port of arrival in the United States,
dispatch a second copy to said Port Director on the vessel
concerned for the guidance of the inspector who will handle the
cargo, and return two copies to the shipper. After the shipment has
been cleared, the shipper must retain one copy of the form and send
one copy, with other shipping documents, to the Area Port Director
at the port of arrival.
6. PART V. The Area Port Director at the port of arrival in the United
States, after executing his certificate on all copies of the form
received by him/her, must retain the original for his/her files, and
forward the two remaining copies to the District Director, Puerto Rico
Operations, TTB, Ste 310 Torre Chardon, 350 Carlos Chardon Ave,
San Juan, PR 00918.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection documents transactions of taxable
commodities on which tax has not been paid. TTB uses the information to determine that the transaction is in accordance with laws and
regulations and establish the person responsible for the tax involved in the transaction. Information requested is mandatory by statute
(26 USC 5314 and 7652).
The estimated average burden associated with this collection of information is 30 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,
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 FORM 5170.7 (01/2011)