Form TTB F 5200.16 TTB F 5200.16 Application for Amended Permit to Manufacture Tobacco Pr

OMB No. 1513-0078 (02/28/2013)
FOR TTB USE ONLY

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

Number

APPLICATION FOR AMENDED PERMIT TO MANUFACTURE
TOBACCO PRODUCTS OR PROCESSED TOBACCO OR TO
OPERATE AN EXPORT WAREHOUSE
1.

This application is submitted to request an amendment to my TTB permit number
Manufacturer of Tobacco Products

2.

to conduct business as a:

Manufacturer of Processed Tobacco

Name and address shown on my permit:

3.

Date

Proprietor of an Export Warehouse

My employer identification number is (Read instruction F) :
―

4.

I have attached my permit to this TTB form for amendment (Read instruction G).
OR
I have NOT attached my permit to this application because:

5.

a.

I have changed my legal name (Read instruction H)

b.

I am removing or adding trade name(s) as follows: (Read instructions I and J)
Remove trade name(s) from my permit:

Add trade name(s) to my permit:

c.

I have attached the document(s) to show this change (such as amended articles of incorporation or trade name certificate).
OR
I have NOT attached the document(s) to show this change because:

6.

I am reporting that the mailing address of my premises has changed (but not its physical location) to:
My new Mailing address is:

7.

I intend to relocate my premises as a Manufacturer of Processed Tobacco. (Read instruction K)
My new Manufacturer of Processed Tobacco premises address is:

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Page 1 of 2

8.

I intend to

✔ relocate,

extend, or

curtail the premises where I manufacture tobacco products. (Read instruction L)

I intend to

relocate,

extend, or

curtail my export warehouse premises. (Read instruction L)

My new premises address is:

I have attached a description and, if necessary, a diagram of my tobacco products factory or export warehouse.
I have NOT attached a description or diagram for the following reason:

9.

I declare that I have read the instructions for this form including the need to file other TTB forms. I understand that I may need to
file these TTB forms before TTB may act on this application. I understand that this application includes the information that I have
attached to this form or to which I have made a reference. I understand that an appropriate TTB officer may require additional
information to determine that I am entitled to the amended permit for which I am applying. Under penalties of perjury, I have
examined this application, and to the best of my knowledge and belief, this application, including any attachments, is true, correct,
and complete.

a.

Signature (See instruction M)

d.

My E-mail Address

b.

c.

Title

e.

Date

My Business Telephone Number

(

)

―

Send this form to the Director, TTB National Revenue Center, 550 Main Street, Suite 8002, Cincinnati, OH 45202.

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Page 2 of 2

OMB No. 1513-0078 (02/28/2013)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

APPLICATION FOR AMENDED PERMIT TO MANUFACTURE TOBACCO PRODUCTS OR
PROCESSED TOBACCO OR TO OPERATE AN EXPORT WAREHOUSE

(INSTRUCTIONS)

1. GENERAL INSTRUCTIONS
A. Why do I need this form? Use this form to amend your permit to manufacture tobacco products or to manufacture
processed tobacco or to operate an export warehouse under Chapter 52 of Title 26 of the United States Code
(Internal Revenue Code). Applying for an amended permit does not authorize you to operate contrary to any Federal,
State, or local laws.
B. When do I have to file this form to amend my permit and do I have to wait for TTB to approve it?
When may I make the
change?

1) You must file this form if
you:

When do I file the
application?

a) Relocate your permit
operations

Before you relocate

Wait for TTB Approval

Item 7 or 8

b) Change the address of
your Permit operations
(not the physical
location)

Within 30 days of the
change

TTB approval not required
before the change

Item 6

c) Extending or curtailing
your premises where
you manufacture
tobacco products or
your export warehouse

Before extending or
curtailing

Wait for TTB Approval

Item 8

d) Change your legal name Within 30 days

TTB approval not required
before the change

Items 5a and 5c

e) Add or remove trade
names

Within 30 days

TTB approval not required
before the change

Items 5b and 5c

2) You are NOT required to
file this form if you:

What do I file with TTB?

When may I make the change?

a) Have a change in
ownership of the
business covered by
your TTB permit

TTB F 5200.3 – change
in ownership requires the
new owner to apply for a
new permit

Wait for TTB Approval

b) Change in officers or
directors of a
corporation

A letter notice reporting the TTB approval not required before the change
change

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Which item on this form
do I complete?

Instructions: Page 1 of 4

1) You are NOT required to
file this form if you:

What do I file with TTB?

When may I make the change?

i. Controlling interest

TTB F 5200.3 – change
in control requires the new
ownership to apply for a
new permit

If TTB F 5200.3 is filed within 30 days, operations may
continue under current permit until new application is
acted upon by TTB

ii. Person(s) holding
more than10%
interest

A letter notice reporting the TTB approval not required before the change
change

c) Change in stock
ownership

d) Have a change in
A letter notice reporting the TTB will advise whether further filings are required.
limited liability company change
Changes that involve actual or legal control of the
membership:
business will require filing for a new permit using TTB
F 5200.3
C. How do I file this form? Send this form to the Director, TTB National Revenue Center, 550 Main Street, Ste. 8002,
Cincinnati, OH 45202. We recommend that you keep a copy of what you send.
D. Can I incorporate information that TTB already has on file? Yes, if you include, from the item(s) filed:
(1) The name, address and TTB permit number that appears on the TTB form referenced;
(2) The TTB form and item number; and
(3) The date that the TTB form was signed.
E. What if there is not enough space for my information? Attach a separate sheet with any additional information.
On this form in the space provided next to the item number, state that you have attached a separate sheet. Any
attachment to this form must include this TTB form number (TTB F 5200.16) and the item number(s) to which the
information corresponds.

INSTRUCTIONS FOR SPECIFIC ITEMS
F. Item 3. What is my employer identification number? This is the nine-digit code that the Internal Revenue Service
(IRS) assigns to your business. If you do not have an employer identification number, you may obtain one by filing an
IRS Form SS-4. You may get this form from the IRS. You may also obtain an EIN by applying online at
www.irs.gov.
G. Item 4. When do I have to attach my permit? You must always attach your permit. If you cannot locate your
permit, you must state this fact.
H. Item 5.
1) What is my legal name?
Your business is a:

Your legal name is:

Sole Proprietorship

Your full name.

Partnership

The name of each partner or the name of the partnership as filed
with a State or local government.

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Instructions: Page 2 of 4

Your business is a:

Your legal name is:

Corporation, association, limited liability
company, or other business organization

The name as stated on your documents filed with the State or local
government.

2) What documents must I file?
If your business is a:

Attach to this application:

Sole Proprietorship

Accurate copy of certificate, issued by State, county, or municipality, which shows the
change in your name.

Partnership or Association

Accurate copy of articles OR the certificate required to be filed by any State, county,
or municipality.

Corporation

Accurate copy of the corporate charter OR certificate of corporate existence or
incorporation, or other corporate document that shows your new legal name.
This copy must be executed by the appropriate officer of the State in which your
business is incorporated.

Limited Liability Company Accurate copy of the business document(s) that shows your new legal name filed
with a State, county, or municipality when such filing is required.
or other business
organization
The copy must show that it was filed with the appropriate government agency.
I.

Item 5. What is a trade name? In general, a trade name is used to identify your business that is not its legal name.
For example, your legal name may be ABC Corporation, but you use ABC Tobacco Products in your business
operations. Business operations include any name with which you identify your business on invoices or letterhead.
Also, business operations include a name that identifies your business on packages of tobacco products or cigarette
papers and tubes.

J.

Item 5. Am I required to have a trade name certificate? Your State, county, or municipal authority may require a
trade name certificate to operate your business under a trade name. If your State, county, or municipal authority does
not require a trade name certificate, state this fact in item 5c.

K. Item 7. Relocation of manufacturer of processed tobacco: State the number, street, city, and State of the location
of your factory premises to be covered by your permit.
L. Item 8. Relocation, extension or curtailment of tobacco products factory or export warehouse:
1) What must I include in my description of my tobacco products factory or export warehouse? State the
number, street, city, and State of the location of your factory or export warehouse premises to be covered by your
permit.
2) When do I need a diagram?
(a) Your tobacco products factory or export warehouse is more than one building and each building cannot be
identified by a separate street address. Identify each building by a letter, number, or similar designation.
(b) Your tobacco products factory or export warehouse uses only a part of a building. Show the floor and room(s)
in the building.
(c) Your tobacco products factory adjoins a retail store. Show any doors or other openings between the factory
and the retail store.

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Instructions: Page 3 of 4

M. Item 12. Who may sign this application?
If your business is a: The application must be signed by:
Sole Proprietorship

You; OR
An individual for whom you have filed an ATF or TTB F 5000.8, Power of Attorney.
Each partner; OR

Partnership

The partner who has been given the authority to sign by the articles of partnership or similar
agreement of all the partners that you have filed for this permit; OR
An individual for whom you filed an ATF or TTB F 5000.8, Power of Attorney.

Corporation,
Association, Limited
Liability Company, or
other business
organization

An individual who has signature authority granted by the business documents that you have
filed for this permit or documented using TTB F 5100.1, Signing Authority for Corporate or
LLC Officials; OR
An individual for whom you have filed an ATF or TTB F 5000.8, Power of Attorney

N. If I have questions about this TTB form, who can answer my questions? Contact a specialist at the TTB
National Revenue Center by phone at 1-877-882-3277, fax at 1-202-453-2338, or e-mail to [email protected].
O. When can I expect my permit? In general, it takes from 2 to 12 weeks before TTB decides on amending your
permit. TTB thoroughly examines the information that you provide with this application. If you omit information or
provide partial information, it will take longer. Also, TTB may request additional information based on the information
that you have provided. If TTB decides not to issue the amended permit, you will receive a written notice stating the
reasons.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act
of 1995. We use this information collection to determine your
identity, location, extent of operations, and eligibility to engage in
operations, and the likelihood that you will conform with Federal
laws and regulations. This information is required from you to
obtain or retain a benefit and is mandatory by law (26 U.S.C.
5712).
We estimate that you will spend 1 hour to complete this form
(average burden associated with this collection of information).
You may spend more or less time depending upon your
individual circumstances. Address your comments concerning
the accuracy of this burden estimate and suggestions to reduce
this burden 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 a collection of
information unless it displays a current valid OMB control
number. In addition, you are not required to respond to a
collection of information unless it displays a current, valid OMB
control number.

PRIVACY ACT INFORMATION
The following information complies with Section 3 of the Privacy
Act of 1974 (5 U.S.C. 552a(e)(3)):

1.

What is TTB’s authority to ask for this information? We
require this information under the authority of 26 U.S.C.
5712. You must provide this information before TTB
decides on whether you may continue your business
allowed under this permit.

2.

What is the purpose for this information collection? You
must provide this information so that TTB will be able to
determine your identity, location, extent of operations, and
eligibility to engage in operations, and the likelihood that you
will conform with Federal laws and regulations.

3.

How does TTB routinely use this information? We use this
information to make determinations for the purposes
described in paragraph 2.
Also, if we are not prohibited by law, we may disclose the
information that you provided on this form to other Federal,
State, foreign, or local law enforcement or regulatory agency
personnel, and to members of the public to verify it. Finally,
we may disclose this information to the Justice Department
if it appears that false information, which constitutes a
violation of Federal law, has been provided.

4.

What is the effect if I do not supply the information TTB
requests? If you fail to supply this information, then it will
delay TTB’s determination as described in paragraph 2.
Also, TTB may disapprove your application if you fail to
supply the information.

TTB F 5200.16 (04/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

Instructions: Page 4 of 4