Form TTB F 5630.5t TTB F 5630.5t Special Tax Registration and Return - Tobacco

OMB NO. 1513-0112 (03/31/2012)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

SPECIAL TAX REGISTRATION AND RETURN – TOBACCO
(Please Read Instructions Sheet Carefully Before Completing This Form)

FOR TTB USE ONLY

TAX

FAILURE TO FILE

FAILURE TO PAY

INTEREST

TOTAL

SECTION I – TAXPAYER IDENTIFYING INFORMATION
EMPLOYER IDENTIFICATION NUMBER(Required see instructions)

BUSINESS TELEPHONE NUMBER

NAME (Last, First, Middle) or CORPORATE NAME (If Corporate)

DOING BUSINESS AS

MAILING ADDRESS (Street address or P.O. Box)

CITY

(

)

STATE

ZIP CODE

STATE

ZIP CODE

ACTUAL LOCATION (if different than above)
PHYSICAL PLACE OF BUSINESS ADDRESS (Street Address)
TAX PERIOD COVERING (only one tax period per form)

CITY

FROM:

(mm/dd/yyyy) TO: June 30,

(yyyy)

SECTION II TAX COMPUTATION
TAX CLASS DESCRIPTION
(for items marked * see instructions)
(a)

MONTHLY
(b)

ANNUAL
(c)

Manufacturer of tobacco products

$83.33 1/3

$1,000

Manufacturer of tobacco products - REDUCED*

$41.66 2/3

$500

Manufacturer of cigarette papers and tubes

$83.33 1/3

$1,000

Manufacturer of cigarette papers and tubes – REDUCED*

$41.66 2/3

$500

Proprietor of export warehouse

$83.33 1/3

$1,000

Proprietor of export warehouse – REDUCED*

$41.66 2/3

$500

LOCATIONS
(d)

MAKE CHECK OR MONEY ORDER PAYABLE TO "ALCOHOL AND TOBACCO TAX AND TRADE
BUREAU", WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK AND SEND IT
WITH THE RETURN TO TTB SOT TAX, 550 MAIN ST, STE 8002, CINCINNATI, OH 45202-5215.

TAX DUE
(e)

CODE
(f)
91
95*
92
96*
93
97*

TOTAL TAX DUE

$ 0.00

Under penalties of perjury, I declare that the statements in this return/registration are true and correct to the best of my
knowledge and belief; that this return/registration applies only to the specified business and location or, where the
return/registration is for more than one location, it applies only to the businesses at the locations specified on the
attached list. Note: Violation of Title 26, United States Code 7206, with respect to a declaration under penalties of perjury,
is punishable upon conviction by a fine of not more than $100,000 ($500,000 in the case of a corporation) or
imprisonment for not more than 3 years, or both, with the costs of prosecution added thereto.
Notice to Cu stomers Making Payment by Check: If you send us a check, it will be converted into an electronic funds
transfer (EFT). This means we will copy your check and use the account information on it to electronically debit your
account for the amount of the check. The debit from your account will usually occur within 24 hours, and will be shown on
your regular account statement. You will not receive your original check back. We will destroy your original check, but we
will keep the copy of it. If the EFT cannot be processed for technical reasons, you authorize us to process the copy in
place of your original check. If the EFT cannot be completed because of insufficient funds, we may try to make the
transfer up to 2 times.
SIGNATURE

TTB F 5630.5t (05/2009)

TITLE

DATE

OMB NO. 1513-0112 (03/31/2012)

SECTION III – BUSINESS REGISTRATION
OWNERSHIP INFORMATION: (Check One Box Only)
INDIVIDUAL OWNER
PARTNERSHIP

CORPORATION

OTHER (Specify)

LLC

OWNERSHIP RESPONSIBILITY: (Read instruction sheet; use a separate sheet of paper if additional space is needed.)
FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

FULL NAME

ADDRESS

POSITION

GROSS RECEIPTS less than $500,000 (See instructions for reduced rate taxpayers on the instruction sheet)
DATE OF COMMENCEMENT (mm/dd/yyyy)

NEW BUSINESS (NOTE: SHOW DATE BUSINESS COMMENCED)

EXISTING BUSINESS WITH CHANGE IN: CHECK APPROPRATE BOX BELOW
DATE OF CHANGE (mm/dd/yyyy)

(a) NAME/TRADE NAME

DATE OF CHANGE (mm/dd/yyyy)

(b) ADDRESS

DATE OF CHANGE (mm/dd/yyyy)

(c) OWNERSHIP

DATE OF CHANGE (mm/dd/yyyy)

(d) EMPLOYER IDENTIFICATION NUMBER
(OLD:
(

-

) (NEW:

-

)

(e) BUSINESS TELEPHONE NUMBER
)

DISCONTINUED BUSINESS

DATE BUSINESS DISCONTINUED (mm/dd/yyyy)

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information is used to ensure compliance
by taxpayers of P.L. 100-647, Technical Corrections Act of 1988, and the Internal Revenue Laws of the United States.
The information collections are used to determine and collect the right amount of tax.
The estimated average burden associated with this collection of information is .8 hour per respondent or record keeper,
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.
(See instructions below)

TTB F 5630.5t (05/2009)

OMB NO. 1513-0112 (03/31/2012)

INSTRUCTION SHEET
TTB FORM 5630.5t - SPECIAL TAX REGISTRATION AND RETURN - TOBACCO
GENERAL INSTRUCTIONS
If you are engaged in one or more of the tobacco activities
listed on this form, you are required to file this form and pay
any special (occupational) tax that is due before beginning
business. You may file one return to cover several locations or
several types of activity. However, you must submit a separate
return for each tax period. The special occupational tax period
runs from July 1 through June 30 and payment is due annually
by July 1. If you do not pay on a timely basis, interest will be
charged and penalties may be incurred.
The special tax rates listed on this form became effective
January 1, 1988. If you were engaged in a tobacco related
activity prior to this date no special occupational tax is due.
If you engage in a taxable activity at more than one location,
attach to your return a sheet showing your name, trade name,
address, employer identification number and the complete
street addresses of all additional locations.
SECTION I - TAXPAYER IDENTIFYING INFORMATION
Complete Section I, Taxpayer Identifying Information, as
specified on the form. Enter the tax period covered by the
return in the space provided. Your return must contain a valid
Employer Identification Number (EIN). The EIN is a unique
number for business entities issued by the Internal Revenue
Service (IRS). You must have an EIN whether you are an
individual owner, partnership, corporation, LLC, or a
government agency. If you do not have an EIN, contact the
Internal Revenue Service immediately to obtain one. While
TTB may assign a temporary identification number (beginning
with XX) to allow initial processing of a return which lacks an
EIN, do not delay submission of your return and payment
pending receipt of your EIN. If you have not received a
number by the time you file this return, write "number applied
for" in the space for the number. Submit your EIN by separate
correspondence after receipt from the IRS.
SECTION II - TAX COMPUTATION
To complete Section II, enter the number of locations in
Column (d) on the appropriate line(s) and multiply by the tax
rate, Column (c). Insert the tax due in Column (e). If you
begin operations after the month of July, then you are
responsible for paying a prorated amount for the portions of the
year you are in business. To compute your taxes, multiply the
monthly rate, Column (b), by the number of locations Column
(d), and then by the number of months, treating parts of
months as whole months, from the date you commenced
operations through June 30. Insert the tax due in Column (e).
(For example, if you commenced operations on March 14, you
would multiply by 4.) Compute the taxes due for each class
and enter the total amount due in the block "Total Tax Due".
INSTRUCTIONS FOR REDUCED RATE TAXPAYERS
The reduced rates for certain taxpayer classes, indicated with
an asterisk (*) in Section II, apply only to those taxpayers
whose total gross receipts for your most recent income tax
year are less than $500,000 (not just receipts relating to the

activity subject to special occupational tax). Further, if you are
a member of a controlled group as defined in section 5061(e)
(3) of the Internal Revenue Code, you are not eligible for this
reduced rate unless the total gross receipts for the entire group
are less than $500,000. If your business is beginning an
activity subject to special tax for the first time, you may qualify
for a reduced rate in your initial tax year if your total gross
receipts for the business (or the entire controlled group, if a
member of a control group) were under $500,000 in the
previous year. If you are eligible for the reduced rate, check
the appropriate box in Section III and compute your tax using
the reduced rate in Section III.
SECTION III - BUSINESS REGISTRATION
Please complete the ownership information in Section III.
Supply the information specified for each individual owner,
partner or responsible person. For a corporation, partnership
or association, a responsible person is anyone with the power
to control the management policies or buying or selling
practices pertaining to tobacco. For a corporation, association
or similar organization, it also means any person owning 10
percent or more of the outstanding stock in the business.
CHANGES IN OPERATIONS
If there is a change of address or location, TTB F 5630.5t must
be completed and submitted within 30 days of the change. All
taxpayers must also contact TTB National Revenue Center;
see contact information below, in order to amend their permit
or to obtain a new one.
If special taxpayers do not register these changes within the
appropriate time frames, additional tax and interest will be
charged and penalties may be incurred. For a change in
ownership or control of an activity, consult the TTB National
Revenue Center before beginning the activity.
SIGNING RETURN
This form must be signed by the individual owner, a partner, or,
in the case of a corporation, an individual authorized to sign for
the corporation.
MAILING INSTRUCTIONS
Please sign and date the return, make check or money order
payable to Alcohol and Tobacco Tax and Trade Bureau, for
the amount in the Total Tax Due block, and mail the form along
with the payment to
SOT TAX
Alcohol Tobacco Tax Trade Bureau
550 Main St.
Ste 8002
Cincinnati, OH 45202-5215
CONTACT INFORMATION
If you need further assistance contact TTB National Revenue
Center at 1-800-937-8864 or 1-877-882-3277 or you may send
an email to [email protected]. Additional information is also
available at our Website, www.ttb.gov.

TTB F 5630.5t (05/2009)