Form TTB F 5110.30 TTB F 5110.30 Drawback on Distilled Spirits Exported

DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

DRAWBACK ON DISTILLED SPIRITS EXPORTED
(See instructions on Page 2)

OMB No. 1513-0042
1. SERIAL NO. (The exporter must
number each form beginning with
"1" each Jan. 1)

PART I - NOTICE
FOR TTB USE ONLY

Notice is hereby given of the shipment of taxpaid distilled spirits which were stamped, restamped, or affixed with
alternative devices and marked especially for export on which drawback of internal revenue tax paid will be
claimed by the bottler or packager.

CLAIM NO.

2. NAME AND ADDRESS OF EXPORTER (Number and Street, City, State, ZIP Code)

DATE REC’D

TTB FORM 5620.4
2
3A. EMPLOYER IDENTIFICATION NUMBER FILED WITH CLAIM NO.
(Bottler or packager)
CLAIMED
$
REJECTED
4. ADDRESS OF THE DIRECTOR NATIONAL REVENUE CENTER (NRC), ALCOHOL AND TOBACCO TAX
$
AND TRADE BUREAU, 550 MAIN ST, STE 8002, CINCINNATI, OH 45202-5215
ALLOWED
$
(Number)
(Location)
5. PURPOSE
FOR EXPORT TO TRANSFER TO:
OF
ARMED FORCES OF
CLAIMS CLERK
FOREIGN-TRADE
CBW
REMOVAL
THE UNITED STATES
$
ZONE
3. NAME AND ADDRESS OF BOTTLER OR PACKAGER

(Make
applicable
entries)

EXPORTATION TO (Name of foreign port and country)

1

USE AS SUPPLIES ON A VESSEL

1

ON AIRCRAFT

6. CONSIGNED DISTRICT DIRECTOR OF CUSTOMS AT PORT OF (Specify)
TO OR IN
CARE OF
(applicable
entries)

TRANSPORTATION OFFICER (Name)

7. NAME OF DOMESTIC CARRIER

(Location)
8. NAME OF EXPORT CARRIER
Number

PROPRIETOR
FOREIGN-TRADE ZONE

(Location)

CBW

9. DESCRIPTION OF DISTILLED SPIRITS REMOVED
KIND
OF
SPIRITS

NUMBER
OF
PACKAGES

(a)

(b)

DATE

CASES
BOTTLES
IN
NUMBER CASE
SIZE
(c)

(d)

SERIAL NUMBERS OF
CONTAINERS OR CASES

(e)

(f)

WINE GALLONS
(Not required
for spirits tax
determined
after 1/1/80)
(g)

PROOF

PROOF
GALLONS

(h)

(i)

BY (Signature and title)

EXPORTER

PART II — DESCRIPTION OF SUPPORTING DOCUMENTS, IF REQUIRED (See Instruction 3)
10.
SERIAL NUMBERS OF
CONTAINERS OR CASES
(a)

RECORD OF TAX
DETERMINATION
SERIAL NO.
(b)

10a. NAME OF BOTTLER OR PACKAGER

DATE
(c)

DUMP BATCH RECORD
SERIAL NO.
(d)

DATE
(e)

PACKAGE
GAUGE
REPORT
DATE
(h)

BOTTLING TANK
RECORD/REPORT
SERIAL NO.
DATE
(f)
(g)

ADDRESS

DRAWBACK
RATE PER
PROOF GALLON
(i)

PLANT NUMBER

PART III — CLAIM
The distilled spirits described In Part I were removed for the purpose stated and are not to be brought back or relanded within the limits of the United States. The kind, quantity, and description of the distilled spirits as stated in
Part I are correct. The distilled spirits were bottled or packaged in the United States by me and were stamped,
restamped, or affixed with alternative devices and marked especially for export. Supporting documents, if required,
are accurately described in Part II. Internal Revenue tax equal to the amount of drawback claimed has been determined as provided by law and regulations, and I am justly entitled to drawback of tax in the amount claimed herein.
No other claim for allowance of drawback has been made under 26 U.S.C. 5062(b) or section 309 of the Tariff
Act of 1930, as amended, on these distilled spirits or any part thereof. Under penalties of perjury, I declare that I
have examined all entries in this form and all supporting documents, and to the best of my knowledge and belief
they are true, correct, and complete.
13. DATE

14. BOTTLER OR PACKAGER

11. AMOUNT CLAIMED
$
12. REQUEST DRAWBACK
ALLOWED TO BE PAID BY
CHECK

CREDIT

14a. BY (Signature and title)

FOOTNOTES
State whether (a) vessel or aircraft operated by the United States; (b) ves(2) the whaling business. Show name of vessel, country of registry, and
sel or aircraft engaged in foreign trade, or in trade between the United
ports of call, or, if a whaling vessel, location of operations. If aircraft, also
States and any of its possessions, or between Hawaii or Alaska and any
show name of airline and country of registry of aircraft.
2
Complete only for consolidated claims; show serial number of last claim
other part of the United States; (c) vessel of the United States engaged In
tabulated.
trade between Atlantic and Pacific ports of the United States; (d) vessel of
war of any foreign nation; or (e) vessel employed in (1) the fisheries, or
1

TTB F 5110.30 (04/2015)

Page 1 of 2

PART IV — CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT
I certify that the distilled spirits described in Part I were found to be as described, except as noted in Item 18, and that the distilled spirits were -15. LADEN FOR
VESSEL (Name)
AIRCRAFT (Name, symbols, number)
EXPORT

USE AS
RAILROAD CAR (Number)
SUPPLIES
16.
RECEIVED IN
(Number)
17. SHIPPED TO (Frontier port)
FOREIGNCBW
TRADE ZONE
18. INSPECTION DISCLOSED
NO EVIDENCE
NO DISCREPANCY OR SHORT
OF TAMPERING
SHORT SHIPMENT, AS FOLLOWS:
19. DATE
20. PORT

TRUCK (State license)
SERIAL NUMBERS OF SEALS USED

21. SIGNATURE AND TITLE OF PROPRIETOR

PART V — CUSTOMS OFFICER'S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
22. FRONTIER PORT

23. DATE RECEIVED

24. INSPECTION DISCLOSED
SEALS
NO EVIDENCE
INTACT
OF TAMPERING

SEALS BROKEN
(See Item 25)

25. DETAILS OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.

26. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 15, BEARING THE SPIRITS
DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED IN ITEMS 18 AND 25, CLEARED
FROM THIS PORT FOR THE PORT OF
27. DATE
28. SIGNATURE AND TITLE OF CUSTOMS OFFICER

(Foreign port)

PART VI - CERTIFICATE OF CLEARANCE OR USE
29. THE EXPORTING CONVEYANCE BEARING THE SPIRITS DESCRIBED IN ITEM 9 WITH EXCEPTIONS AS NOTED ABOVE CLEARED FROM
THE PORT OF
ON (Date)
BOUND FOR (Name of foreign port and country)

30.

THE DISTILLED SPIRITS HAVE BEEN USED AS
31. DATE
32. SIGNATURE OF DISTRICT DIRECTOR OF CUSTOMS
SUPPLIES ON THE FISHING VESSEL OR AIRCRAFT IDENTIFIED ABOVE, AND THE REQUIRED
EVIDENCE OF SUCH USE HAS BEEN RECEIVED
PART VII — CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
The distilled spirits described in Item 9, with exceptions as noted in Item 34, were received for export to the Armed Forces of the United States. The distilled
spirits will not be shipped for consumption or use in any place subject to application of the internal revenue laws of the United States.
33. DATE

34. DISCREPANCIES

35. SIGNATURE

36. RANK

37. TITLE

INSTRUCTIONS
1. General. Prepare this form in quadruplicate, except prepare a fifth
copy, marked "Consignee's Copy," when the shipment is for use on
aircraft.
2. Part I. The exporter must complete Part I.
3. Part II. The bottler or packager must complete Part II if the spirits
were tax-determined before January 1, 1980 (see (a), below) or if the
spirits were tax-determined after January 1, 1980 and the drawback rate
exceeds $10.50 per proof gallon (see (b), below).
(a) Spirits tax-determined before January 1, 1980. Claims for spirits
tax-determined before January 1, 1980, must be supported by a copy of
each related dump and batch record, bottling tank report, and/or package
gauge report covering the processing, bottling, and/or packaging of the
spirits. Claims on spirits bottled in bond on bonded premises before January 1, 1980, must be supported by a copy of ATF Form 179 covering
the tax-determination of the spirits. These supporting documents must be
iden-tified In the appropriate columns in Part II, along with the drawback
rate for each product. If a standard drawback rate was established prior to
January 1, 1980, the date of approval of the formula and the number
must be shown in any available space in Part II. If the claim covers the
products made with imported spirits (other than such spirits withdrawn
from internal revenue bond) or imported wines, the claimant must
furnish evidence of tax payment for the spirits or wines (such as Customs
Forms 7505 or 7501 receipted to indicate the payment of taxes).
(b) Spirits tax-determined after January 1, 1980, and the drawback
rate exceeds $10.50 per proof gallon. Claims for these spirits must be
supported by a copy of each related dump and batch record, bottling tank
record, and/or package gauge report covering the processing, bottling, and/
or packaging of the spirits. If the claim covers products made with imported
spirits (other than such spirits withdrawn from internal revenue bond) or
imported wines, the claimant must furnish evidence of tax payment for the
spirits or wines (such as Customs Forms 7505 or 7501 receipted to indicate the payment of taxes).
4. Part III. The bottler or packager must complete Part III and indicate in
Item 12 whether the claim is for a check remittance or a credit to be taken
on the distilled spirits tax return, TTB F 5000.24. In addition to supporting
documents required in some cases (see Part II, above), all claims must be
supported by the bill of lading required by 27 CFR 28.250. For spirits taxdetermined after January 1, 1980, all claims must be supported by an invoice, bill of lading, or other document which identifies the date of taxdetermination, unless the bill of lading, required by 27 CFR 28.250 identifies this date.
5. Distribution. On removal of the spirits, the exporter must forward
the original and one copy to the official designated in Item 6. If there
is a "Consignee's Copy" (see Instruction No. 1), the exporter must forward

it to the airline company at the airport. If the exporter is not the bottler or
packager, he/she must furnish two copies to the bottler or packager.
Claims must be filed with the Director, NRC, by the bottler or packager
and must be accompanied by the necessary supporting documents.
6. Actions By Customs. (a) Vessels Other Than Fishing Vessels. After
inspection of lading, the Cus-toms officer must execute Part IV on both
copies and forward them to the District Director of Customs. On clearance
of the conveyance, the District Director of Customs must execute Part VI,
forward the original to the Director NRC, Alcohol and Tobacco Tax and
Trade Bureau at the address shown in item 4 and retain the copy for his/her
files.
(b) Use on Aircraft and Fishing Vessels. After inspection of lading,
the Customs officer must execute Part IV on both copies and forward them
to the District Director of Customs. The District Director of Customs, on
receipt of the required "Certificate of Use" (for aircraft) or Customs Form
5125 (for fishing vessels), must execute Part VI, forward the original to the
Director, NRC, Alcohol and Tobacco Tax and Trade Bureau, at the address shown in item 4, and retain the copy for his/her files.
(c) Lading at Interior Port For Exportation Through Frontier Port. On
completion of lading the Customs officer must affix the seal, then execute
Part IV on both copies and forward them to the District Director of Customs
at the interior port of lading for forwarding to the Customs officer at the
frontier port. Provided that where the shipment is by truck and where instructions from the District Director of Customs so provide, the copies may
be forwarded via the truck driver to the Customs officer at the frontier port.
That officer, when satisfied that the shipment has been exported, must
execute Part V on both copies and return them to the District Director of
Customs at the interior port. The District Director of Customs must then
execute Part VI, forward the original to the Director, NRC, Alcohol and
Tobacco Tax and Trade Bureau, at the address shown in item 4, and retain
the copy for his/her files.
(d) Receipt in Foreign - Trade Zone. On receipt of the spirits, the Customs officer must execute Part IV on both copies, forward the original to
the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau, at the
address shown In item 4, and retain the copy for his/her files.
(e) Receipt in Customs Bonded Warehouse. On receipt of the shipment, the Customs officer must execute Part IV on both copies, forward the
original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau,
and keep a copy for his/her files.
7. Action by Armed Forces Officer. On receipt of the spirits, the officer to
whom consigned (or other authorized supply officer) must execute Part
VII on both copies, forward the original to the Director, NRC, Alcohol and
Tobacco Tax and Trade Bureau, at the address shown in item 4, and retain
the copy for his/her files.

Page 2 of 2

TTB F 5110.30 (04/2015)

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the, Paperwork Reduction Act of 1995. The information collection is used to obtain drawback of taxes on
articles which are exported. This information is required to obtain a benefit (26 U.S.C. 5062).
The estimated average burden associated with this collection of information is 2 hours 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, 1310 G Street, NW., Washington,
DC 20005.
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.

PRIVACY ACT STATEMENT
1. Authority. Solicitation of this information is made pursuant to 26 U.S.C. 5062. Disclosure of this information is used to obtain drawback of
Federal excise taxes on distilled spirits exported.
2. Purpose. We use information on this form to identify the claimant, the tax-paid spirits exported, the amount of tax to be refunded. The form
also verifies the exportation of the spirits via a certification by a U.S. government agent. We use the information on this form to establish
excise tax liability and to prevent jeopardy to the revenue.
3. Routine Uses. We use this information to make determinations for the purposes described in paragraph 2. Also, we may disclose the
information to other Federal, State, foreign, and local law enforcement and regulatory agency personnel to verify information on the form where
law does not prohibit such disclosure. We may disclose the information to the Justice Department if it appears that the furnishing of false
information may constitute a violation of Federal law. Finally, we may disclose the information to members of the public in order to verify
information on the form where law does not prohibit such disclosure.
4. Effects of Not Supplying Information Requested. If you fail to supply complete information, we cannot verify and process your claim for
drawback of excise taxes already paid on distilled spirits exported from the United States.

TTB F 5110.30 (04/2015)