Form TTB F 5620.7 TTB F 5620.7 Claim for Drawback of Tax on Tobacco Products, Cigarette

OMB No. 1513-0026 (03/31/2012)

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

CLAIM FOR DRAWBACK OF TAX ON TOBACCO PRODUCTS, CIGARETTE
PAPERS, AND CIGARETTE TUBES

FOR TTB USE ONLY
CLAIM NUMBER DATE OF AUDIT
AUDITED BY

(See Instructions b e l o w)
PART I - REQUEST FOR INSPECTION
1.

CHECK ONE

These articles taxpaid under
26 U.S.C. 5701. (Produced in
U.S. or a foreign country)

These articles taxpaid under
26 U.S.C. 7652(a). (Produced
in Puerto Rico)
2.

TO:

These articles taxpaid under
26 U.S.C. 7652(b). (Brought
in from the U.S. Virgin Islands)

TO BE SHIPPED TO (Name and Address)

Director, National Revenue Center
Alcohol and Tobacco Tax and Trade Bureau
550 Main St, Ste 8002
Cincinnati, Ohio 45202-5215

I request that an officer of the Alcohol and Tobacco Tax and Trade Bureau be assigned to inspect tobacco products, cigarette papers, or cigarette tubes,
on which I have paid the tax, and which are to be shipped to a foreign country, Puerto Rico, the U.S. Virgin Islands, or a possession of the United States
with the benefit of drawback of tax, as provided for by the regulations in 27 CFR, Part 44.
3. LOCATION WHERE ARTICLES ARE HELD (Number, street, city or to wn, State, and ZIP Code)
4.

NAME AND MAILING ADDRESS OF TAXPAYER (Street address, P.O. Box or R.F.D. number, city, State, and ZIP Code)

5.

SIGNATURE OF TAXPAYER (if officer of cor poration, give title)

NUMBER
KIND OF
MARKS &
OF
ARTICLES
NUMBERS ON
CONTAINERS (Small cigarettes,
SHIPPING
Large cigars, Chewing
CONTAINERS
Tobacco, Snuff, etc.)
(a)

(b)

(c)

6.

TAXPAYER’S EMPLOYER IDENTIFICATION 7.
NUMBER

PART II - CLAIM
8. SCHEDULE OF ARTICLES FOR EXPORT
SALE
NUMBER OF
TOTAL
TOTAL PRICE 2
PRICE
POUNDS/
NUMBER
Col. (d) x Col. (f)
OUNCES IN
OR POUNDS/
PER 1,000 1
Divided by
EACH
OUNCES
1,000
CONTAINER
(d)

(e)

(f)

(g)

DATE

RATE
OF TAX

AMOUNT
OF TAX
CLAIMED

(h)

(i)

ROLL-YOUR-OWN TOBACCO
PIPE TOBACCO
CIGARS
TOTAL
$
CIGARETTES
CHEWING TOBACCO
SNUFF
1 Complete only for large cigars. Enter the taxable sale price per thousand.
2 Complete only for large cigars with a sale pr ice of not more than $ 763.222 per thousand.
Under penalties of perjury, I declare that this claim for drawback of Internal Revenue tax is, to the best of my knowledge and belief, true and accurate; I
have paid the tax on the tobacco products , cigarette papers, or cigarette tubes, to be shipped to a f oreign country, Puerto Rico, the U.S. Virgin Islands,
or a possession of the United States , or to a foreign-trade zone; no other allowance of drawback has been made or claimed on the tob acco products,
cigarette papers, or cigarette tubes, or any part thereof; and I am justly entitled to a dr awback of tax.
9.

SIGNATURE OF CLAIMANT

10. TITLE OR STATUS (State whether individual owner, member
of firm, or if officer of corporation, and give title)

11. DATE

PART III - TTB OFFICER’S REPORT OF INSPECTION
I have inspected the ar ticles and find that Part II, Item 8, is complete and accur ate; the packages of tobacco products, cigarette papers, or cigarette tubes,
have attached thereto the required label; the ar ticles were packed under my supervision in shipping containers; and each container has been mar ked and
numbered, as indicated in Part II, Item 8, and released to the claimant f or export.
TTB F 5620.7 (03/2010)

Page 1 of 2

12. SIGNATURE OF TTB OFFICER

PART III - TTB OFFICER’S REPORT OF INSPECTION (Continued)
13. TITLE

14. DATE

PART IV - CUSTOMS CERTIFICATE
SECTION A - CUSTOMS CERTIFICATE OF RECEIPT IN FOREIGN-TRADE ZONE
Except as indicated below all the containers of ar ticles described in Part II, Item 8, w ere received intact in a foreign-trade zone for storage pending subsequent shipment to a f oreign country, Puerto Rico, the U.S. Virgin Islands, or a possession of the United States .
15. FOREIGN-TRADE ZONE LOCATION
16. DATE RECEIVED
17. DISCREPANCIES (if none, so state)

18. SIGNATURE OF CUSTOMS OFFICER

19. TITLE

SECTION B - CUSTOMS CERTIFICATE OF LADING AND EXPORT
The articles described in Part II, Item 8, except as indicated in Item 22, w ere laden and the vessel cleared or depar ted the port as shown below:
20. IDENTITY OF CARRIER ON WHICH LADEN

21. DATE OF LADING

22. DISCREPANCIES (if none, so state)

23. SIGNATURE OF CUSTOMS OFFICER

24. TITLE

25. DATE CLEARED OR DEPARTED

26. SIGNATURE OF CUSTOMS OFFICER

27. TITLE

PART V - POST OFFICE CERTIFICATE
28. U.S. POSTAL SERVICE ENDORSEMENT (Include date of
The shipping containers described in Part II, item 8, were placed in the mail under m y
mailing)
supervision, addressed as indicated in P art I, item 2, and there w as stamped or wr itten
on each shipping container a w aiver signed by the exporter of his/her right to withdraw
such container from the mail.

INSTRUCTIONS
CLAIMANT - The claimant must prepare Part I in connection with each claim f or drawback of tax paid on tobacco products , cigarette papers, or cigarette
tubes, and forward three copies of the executed forms to the Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau, 550 Main St,
Ste 8002, Cincinnati, OH 45202-5215. This form must be accompanied by a bond on TTB F 5200.17.
A TTB officer will inspect the articles, supervise the attachment of the required label on the packages, supervise the packing in shipping containers, and
release the shipping containers to the claimant. The claimant must then execute Part II on all copies of the form and return them to the TTB officer who
will execute Part III on all copies, retain one copy, and furnish two copies to the claimant.
CUSTOMS - Except for exportation through the U.S. Postal Service, the claimant will present these two copies of the form with the shipment to the
Customs Officer at the port of exportation or at the foreign-trade zone, who will execute the appropriate certificate in Part IV, retain one copy for his/her
records, and forward one copy to the National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau shown in Part I.
POSTAL SERVICE - If the shipment is e xported through the U.S. Postal Service, the claimant must stamp or wr ite on each shipping container a signed
waiver of his/her right to withdraw the ar ticles from the mail, present one copy of this form with the shipment to the P ostal Service for the cer tificate in
Part V, and transmit such copy to the National Revenue Center, shown in Part I.
CLAIMANT - In addition to this form the claimant is also required to furnish the National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau
shown in Part I, a lading certificate or other evidence as required by 27 CFR Part 44.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the P aperwork Reduction Act of 1995. The information collection is used to obtain dr awback of taxes on ar ticles which
are exported. This information is required to obtain a benefit b y 26 U.S.C. 5706.
The estimated average burden associated with this collection of inf ormation is 30 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 addressed to the Report
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 5620.7 (03/2010)