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DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
SPECIAL TAX “RENEWAL” REGISTRATION AND RETURN
(TAX PERIOD 7/1/2012 – 6/30/2013) (See separate instruction sheet)
SECTION I – TAXPAYER IDENTIFYING INFORMATION
1. EMPLOYER IDENTIFICATION NUMBER
BUSINESS TELEPHONE
(
)
-
2. OWNERSHIP INFORMATION
(Check One Box Only)
INDIVIDUAL OWNER
PARTNERSHIP
3.
OTHER
CORPORATION
TOBACCO PRODUCTS MANUFACTURERS
AND TOBACCO EXPORT WAREHOUSE
PROPRIETORS (with gross receipts less than
$500,000 for most recent tax year.)
SECTION II – CORRECTIONS TO PREPRINTED TAXPAYER IDENTIFYING INFORMATION
(Complete ONLY if needed, and ONLY for the items requiring changes)
4. NAME (Last, First, Middle) or CORPORATE NAME (if Corporation)
6. MAILING ADDRESS
5. TRADE NAME
7. CITY, STATE, ZIP CODE
9. EMPLOYER IDENTIFICATION NUMBER
8. DATE OF CHANGE (mm/dd/yyyy)
-
-
10. BUSINESS TELEPHONE NUMBER
SECTION III – CHANGE IN OWNERSHIP – STATUS (Check and complete as applicable)
11.
12
The person identified above no longer owns the business or is no longer engaged in the operations covered by this special
tax “renewal” registration and return. (Please complete Section V below.)
DATE BUSINESS DISCONTINUED
(mm/dd/yyyy)
I am the new owner of the business location identified above. I commenced business operations on
(mm/dd/yyyy). (Please complete Section II above, and Sections IV and V below. As needed, correct/change the Special
Tax Location Registration information.)
SECTION IV – TAX COMPUTATIONS (See Enclosed Tax Class Reference Chart)
13.
(a)
TAX CLASS
OFFICIAL
USE ONLY
FAILURE TO FILE
(b)
TAX
CODE
FAILURE TO PAY
(c)
NUMBER OF
LOCATIONS
INTEREST
(d)
TAX RATE
($)
TOTAL
(e)
TAX DUE
($)
14. TOTAL DUE
IF YOU OWE SPECIAL TAX FOR THIS TAX PERIOD, YOU MUST SUBMIT PAYMENT BY JULY 1, 2012
MAKE CHECK OR MONEY ORDER PAYABLE TO “ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)”, WRITE YOUR EMPLOYER
IDENTIFICATION NUMBER ON THE CHECK AND SEND IT WITH THE RETURN TO SOT TAX, 550 MAIN ST., STE 8002, CINCINNATI, OH 45202
SECTION V – TAXPAYER CERTIFICATION
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 business operations at the locations specified on the attached Special Tax Location Registration
Listing. 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.
15. SIGNATURE
TTB F 5630.5R (03/2012)
16. TITLE
17. DATE
Page 1 of 5
OMB No. 1513-0113 (06/30/2014)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
SPECIAL TAX LOCATION REGISTRATION LISTING
(RENEWAL BUSINESS – TAX PERIOD 7/1/2012 – 6/30/2013)
INSTRUCTIONS
1. Review and verify that all preprinted business location information is correct.
2. A full street address or rural route description for the actual physical location of the business is required. A post office box number
is unacceptable, and if left uncorrected may delay or prevent registration of the location as required by law.
3. If any preprinted business location information is incorrect, line through the incorrect business location information and clearly print
or type the correct business location information.
4. If a business location is no longer in business, line through all preprinted business location information pertaining to that business
location; print or type the words “OUT OF BUSINESS”; and, show the date business activities ceased at the business location.
5. Enter business location information for new business locations in the space provided below. Please print or type all business
location information entered for each new business locations.
EMPLOYER IDENTIFICATION NUMBER:
─
TTB
TAX
LOCATION CLASS
NUMBER CODE
TTB F 5630.5R (03/2012)
TRADE NAME
LOCATION ADDRESS
Page 2 of 5
BUSINESS
TELEPHONE
NUMBER
CITY,
STATE, ZIP CODE
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
OMB No. 1513-0113 (06/30/2014)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
SPECIAL TAX LOCATION REGISTRATION LISTING
(RENEWAL BUSINESS – TAX PERIOD 7/1/2012 – 6/30/2013)
EMPLOYER IDENTIFICATION NUMBER:
─
TTB
TAX
LOCATION CLASS
NUMBER CODE
TRADE NAME
BUSINESS
TELEPHONE
NUMBER
CITY,
STATE, ZIP CODE
LOCATION ADDRESS
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
(
)
-
DO NOT WRITE IN THE SPACE BELOW EXCEPT TO ADD A NEW BUSINESS LOCATION
TRADE NAME
BUSINESS TELEPHONE NUMBER
(
LOCATION ADDRESS
TAX CODE
TTB F 5630.5R (03/2012)
)
-
CITY, STATE, ZIP CODE
TAX CLASS
DATE NEW LOCATION STARTED BUSINESS (mm/dd/yyyy)
Page 3 of 5
OMB No. 1513-0113 (06/30/2014)
SUPPLEMENTAL INSTRUCTION SHEET FOR COMPLETING
SPECIAL TAX “Renewal” REGISTRATION AND RETURN, TTB FORM 5630.5R (03/2012)
ATTENTION “PERMITTEES”
If you are no longer engaged in the operations authorized by the Alcohol and Tobacco Tax and Trade Bureau (TTB), and
have complied with all requirements for discontinuance (e.g., disposal of tobacco, filing of final report(s), etc.), you are
authorized to submit your Permit(s) and/or Notices for cancellation with this Special Occupational Tax (SOT) Renewal.
Make sure that you have completed Items 11, 15, 16, and 17 on the front of this form. Such cancellation will not affect
your right to reapply in the future. However, you may not engage in any operations requiring authorization until you have
re-qualified.
If you have a permit, but you ARE NOT CONDUCTING BUSINESS for which you have been issued a permit, you MUST
FILE this tax return and attach a statement saying that you are currently “INACTIVE” and file a new tax return before
conducting any operations in this tax year.
For assistance in disposing of tobacco, or if you need other information regarding documents to be filed, please contact
the TTB National Revenue Center at 1-877-882-3277, or (513) 684-3334 between 8 A.M. and 5 P.M. EST.
Item 1 – Taxpayer Identifying Information – If any
taxpayer identifying information in Block 1 is incorrect,
enter only the corrected information in the appropriate
block in Section II.
Your tax return must contain a valid Employer
Identification Number (EIN). A missing or incorrect EIN
will result in a delay in the processing your special tax
registration and return form, and in the issuance of a
special tax stamp. An 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, or an agency of
the government.
If you do not have an EIN, contact your local IRS office
immediately to obtain one. If you submit a special tax
registration and return form that does not have an EIN,
TTB may assign a temporary identification number
(beginning with XX) to allow initial processing of the
special tax registration and return form. However, a
special tax stamp, TTB Form 5630.6A, will not be issued
until you have notified us of the issuance of a valid EIN. If
your special tax registration and return form has an XX
number or an incorrect EIN in Item 1, be sure to enter the
correct EIN in Item 9.
Do not delay the submission of your special tax
registration and return form, and any payment, past the
due date pending the receipt of a valid EIN. Submit your
EIN by separate correspondence after receipt from the
IRS.
Item 2 – Check only one box to describe the type of
ownership of the business identified in Item 1.
Item 3, – Reduced Rate Taxpayers and Exempt Activities
– You must declare your eligibility for a reduced rate
or special tax exemption each year. The regular rates
are used to compute the amounts shown as due on
the special tax registration and return form.
TTB F 5630.5R (03/2012)
Check Item 3 only if you are a tobacco products
manufacturer or you are the proprietor of a tobacco export
warehouse, and the gross receipts for your entire
business, from all sources (not just receipts relating to the
activity subject to special occupational tax), was less than
$500,000 for the tax year immediately preceding this tax
year.
If your business meets these conditions, you are eligible
for a reduced tax rate and may compute your tax using the
appropriate reduced tax rate shown on the enclosed Tax
Class Reference Chart. However, 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 a reduced
rate unless the total gross receipts for the entire group are
less than $500,000.
Item 11 – If you have discontinued business
operations, check Item 11 and enter the date of
discontinuance in the space provided and complete
Section V.
Item 12 – If you are the new owner of the business, check
Item 12 and complete Sections II, IV and V. Also, correct
any errors on the Special Tax “Renewal Registration and
Return.
Item 13 – If tax payment is due, the amount shown in
Column 13(e), as tax due, is computed by multiplying the
number of locations, Column 13(c), by the tax rate,
Column 13(d). Add additional tax classes (if necessary) in
the vacant spaces provided or attach additional sheets.
Item 15 – If tax payment is due, the total tax due is
computed by adding the figures in Column 13(e).
If the preprinted information in Section IV is incorrect, line
through the incorrect items(s) and write in the correct
information alongside the lined out item(s).
See the enclosed Tax Class Reference Chart for tax class
and tax rate information.
Page 4 of 5
OMB No. 1513-0113 (06/30/2014)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
TAX CLASS REFERENCE CHART
TAX YEAR 2013
TAX
CLASS
DESCRIPTION
Manufacturer of tobacco products
TAX
RATE
$1,000
Manufacturer of tobacco products – REDUCED*
TOBACCO
PRODUCTS
Manufacturer of cigarette papers and tubes
$500
$1,000
Manufacturer of cigarette papers and tubes – REDUCED*
Proprietor of export warehouse
$500
$1,000
Proprietor of export warehouse – REDUCED*
$500
TAX
CODE
STATUS
91
PAYABLE
95*
PAYABLE
92
PAYABLE
96*
PAYABLE
93
PAYABLE
97*
PAYABLE
See supplemental instructions for explanation of Reduced Rates.
IF YOU NEED FURTHER ASSISTANCE
CONTACT THE NATIONAL REVENUE CENTER
at 1-800-937-8864 or (513) 684-2979
PAPERWORK REDUCTION ACT
This information is used to ensure compliance by taxpayers with P.L. 100-203, Revenue Act of 1987, P.L. 100647, Technical Corrections Act of 1988, and the Internal Revenue laws of the United States. The Alcohol and
Tobacco Tax and Trade Bureau (TTB) use the information to determine and collect the right amount of tax.
The estimated average burden associated with this collection is 15 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 directed 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, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control number.
PRIVACY ACT
A Privacy Act Statement required by 5 U.S.C. 552a(e)(3) stating our authority for soliciting and collecting the
information from your check, and explaining the purposes and routine uses which will be made of your check
information, is available at http://www.ttb.gov/pdf/notice-of-system-records.pdf, or call toll free at (877) 8823277 to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so may
require you to make payment by some other method.
Notice to Customers 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.
TTB F 5630.5R (03/2012)
Page 5 of 5
| File Type | application/pdf |
| File Title | OMB NO |
| Author | TTB |
| File Modified | 2012-03-05 |
| File Created | 2012-02-28 |