Form TTB F 5110.51 TTB F 5110.51 Application, Permit, and Report - Distilled Spirits Prod

OMB No. 1513-0123 (03/31/2013)

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

1. Serial No.

APPLICATION, PERMIT, AND REPORT-DISTILLED SPIRITS PRODUCTS (Puerto Rico)
(Prepare in Quintuplicate. See instructions below.)

PART I APPLICATION
TO THE SECRETARY OF THE TREASURY OF PUERTO RICO
Application is hereby made for a permit to compute the tax on, taxpay, and withdraw for shipment to the United States, the following described liquors or
articles made with distilled spirits:
2. DESCRIPTION OF LIQUORS OR ARTICLES MADE WITH DISTILLED SPIRITS
FORMULA (If any)
CONTENTS
MANUFACTURED BY
SERIAL
SERIAL NUMBERS
PROOF
DATE
FORM
NUMBER
NAME
LOCATION
PROOF GALLONS
OF PACKAGES
APPROVED
NUMBER
(IF ANY)
(a)
(h)
(b)
(g)
(c)
(f)
(d)
(e)

3. TO BE RELEASED FROM

3a. OPERATED BY:

DISTILLER’S
BONDED WAREHOUSE

RECTIFIER'S
BONDED WAREHOUSE

PUBLIC
BONDED WAREHOUSE

BONDED PROCESSING
ROOM NO.

4.

3b. LOCATED AT:

I have on file with the District Director, Alcohol and Tobacco Tax
and Trade Bureau (TTB), a good and sufficient bond, TTB F 5110.50,
and desire to withdraw the liquors or articles made with distilled spirits
on computation, but before payment, of the tax.

5. DATE

I desire to prepay the computed tax before withdrawal of the liquors
or articles made with distilled spirits.

6. NAME OF APPLICANT

6a. BY (Signature and capacity)

PART II — PERMIT TO COMPUTE TAX
TO COMMONWEALTH INTERNAL REVENUE AGENT
7. Permit is hereby granted to the above-named applicant to compute the tax on the liquors or articles made with distilled spirits described in Part I, and to:
Defer payment of the computed tax
8. DATE

9. SECRETARY

Prepay the computed tax
9a. BY (Signature and official title)

PART III — COMPUTATION OF TAX AND STATEMENT OF TAX PAYMENT
To

DISTRICT DIRECTOR (INVESTIGATIONS), PUERTO RICO OPERATIONS (if the computed tax is to be prepaid)
COMMONWEALTH INTERNAL REVENUE AGENT (if the computed tax is to be deferred)

10. TOTAL PROOF GALLONS

11. TOTAL DISTILLED SPIRITS TAX

12. CHECK APPLICABLE BOX
TTB F 5000.25, with remittance in full for the total amount of the above tax, is transmitted herewith.
I agree to pay, as required by law and regulations, the total amount of tax shown in item 11 and I declare, under the penalties of perjury, that I am
not in default in any payment of tax chargeable against my bond, TTB F 5110.50, and that such bond is in the maximum penal sum, or is sufficient
to cover that amount in addition to all other amounts chargeable against such bond.
13. DATE

TTB F 5110.51 (04/2010)

14. NAME OF APPLICANT

14a. BY (Signature and capacity)

PART IV — REPORT OF PREPAID TAXES
TO THE COMMONWEALTH INTERNAL REVENUE AGENT
TTB F 5000.25, with remittance in the full amount of the tax shown in Part III, has been received.
15. DATE

16. DISTRICT DIRECTOR (INVESTIGATIONS),
PUERTO RICO OPERATIONS

16a. BY (Signature and official title)

PART V — REPORT OF RELEASE
TO THE SECRETARY OF THE TREASURY OF PUERTO RICO
17.
TTB F 5000.25, with remittance in full, has been received by the District Director (Investigations), Puerto Rico Operations.
The applicant has on file a good and sufficient bond covering the taxes described in Part III; therefore, the liquors or articles made with distilled
spirits described in Part I have been released.
18. DATE

19. REVENUE AGENT

INSTRUCTIONS

GENERAL. The applicant must prepa re his/her form in quintuplicate.
Forms must be s erially numbered, beginning with "1" each calendar year,
and running con secutively therea fter to the e nd of the year. The serial
number must be prefixed by the last two digits of the year, e.g., “10-1.”
2. PART I. After executing Part I, the applicant must forward all copies
of the form to the Secretary of the Treasury of Puerto Rico.
3. PART II. After executing the permit in Part II, the Secretary must retain
one copy for his/her files and forward the original and remaining copies to
the revenue ag ent at the prem ises where the liquors or articles are
stored. The reve nue agent must gauge the liquors or articles, make a
report of this gauge, and deliver all copies of this for m and TTB F 5000.25
to the applicant.
4. PART III
(a) PREPA YMENT. If the tax is to be prepaid, the applicant m ust so
indicate in Part Il l. On executing Part III, the a pplicant must pre pare TTB
F 5000.25 in accordance with the instructions thereon, and send al l copies of this form, all copies of TT B F 5 000.25, an d the f ull amoun t of the
tax, to the District Director (Investigations), Puerto Rico Operations, TTB.

(b) DEFERRED PAYMENT. If the t ax is to b e deferred, the applicant
must, after executing his/her agreement to pay in Part Ill, deliver all copies
of this form and all copies of TTB F 5000.25 to the revenue agent.
5. PART IV. This part must be dated and signed b y the District Dir ector
(Investigations), Puerto Ri co Operations, TTB, if the ta x is prep aid.
He/she must then forward one copy of TTB F 5000.25, to the Secretary,
and four copies of this fo rm and t he ga uge repo rt, if any, to the
revenue agent, and retain the original of each form for his/her files.
6. PART V. This part must be executed by the revenue agent after determining that the applicant has pr oper bo nd cover age, or, in the case of
prepayment, on receipt of this form from the District Director (Investigations),
Puerto Ri co Op erations repo rting his /her receipt of TTB F 5000.25
with remittance in full. The revenue agent must then forward one
copy of this form and the gauge report, if any, to the Insular Liquor Bureau,
and one copy of each to the District Revenue Agent (Commonwealth
of Puerto Rico), deliver on e copy of each to the applicant s, and retain
one cop y of each for his/her files.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine the eligibility of the person
to compute the tax on, taxpay, and withdraw liquors or articles made with distilled spirits. The information is mandatory by statute (26 U.S.C. 7652).
The estimated average burden associated with this information collection is 1 hour per respondent or recordkeeper depending on the individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed 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 F 5110.51 (04/2010)