Form F 5220.6 F 5220.6 Monthly Report — Importer of Tobacco Products or Process

OMB No. 1513-0107 (02/28/2013)

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

MONTHLY REPORT - TOBACCO PRODUCTS OR PROCESSED TOBACCO IMPORTER
INSTRUCTIONS: Please type or print. Prepare in duplicate, retain the copy, and submit the original to the TTB National Revenue Center, 550 Main St, Ste 8002, Cincinnati, Ohio 45202-5215, not later than the
15th day of the month following the end of the month for which report is made. Combine data for all locations covered by a single permit. Report quantities of chewing tobacco, snuff, pipe tobacco, roll-your-own tobacco,
and processed tobacco in pounds and fractions of a pound rounded to two decimal places.
2. PRINCIPAL BUSINESS ADDRESS (Number, Street, City, State, and ZIP Code)

1. NAME OF IMPORTER

3. MONTH AND YEAR

4. PERMIT NUMBER

5. EMPLOYER IDENTIFICATION NUMBER (EIN)
―

SMALL CIGARETTES LARGE CIGARETTES
ARTICLE

ROLL-YOUR-OWN

PROCESSED

SMALL CIGARS

LARGE CIGARS

SNUFF

CHEWING TOBACCO

PIPE TOBACCO

TOBACCO

TOBACCO

(Number)

(Number)

(Number)

(Number)

(Pounds)

(Pounds)

(Pounds)

(Pounds)

(Pounds)

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

6. On Hand, Beginning of
Month
7. Imported and Released
from Customs Custody into
the United States
8. Received from Other
Sources
9. Overage Disclosed by
Inventory
10. Returned from Domestic
Customers

11. TOTAL

TTB F 5220.6 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

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SMALL CIGARETTES LARGE CIGARETTES
ARTICLE

ROLL-YOUR-OWN

PROCESSED

SMALL CIGARS

LARGE CIGARS

SNUFF

CHEWING TOBACCO

PIPE TOBACCO

TOBACCO

TOBACCO

(Number)

(Number)

(Number)

(Number)

(Pounds)

(Pounds)

(Pounds)

(Pounds)

(Pounds)

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

12. Removed for Export
Purposes
13. Transferred to Domestic
Customers
14. Removed to a Foreign
Trade Zone
15. Returned to Customs
Custody

16. Lost

17. Destroyed

18. Shortages Disclosed By
Inventory

19. On Hand, End of Month

20. TOTAL

Under the penalties of perjury, I declare that I have examined this report and, to the best of my knowledge and belief, it is true, correct, and complete.
21. SIGNATURE

22. DATE

23. E-MAIL ADDRESS

24. TITLE OR STATUS (State whether individual owner, partner, member of a limited liability company, or if officer of corporation, give title)

AUDITED BY

25. TELEPHONE NUMBER

(
TTB F 5220.6 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

FOR TTB USE ONLY

)

DATED AUDITED

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PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is to establish product accountability and to compile data for statistical purposes. The
information is mandatory (26 U.S.C. 5722).
The estimated average burden associated with this collection of information is 56 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 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 an individual is not required to respond to, a collection of information unless it displays a current, valid OMB control number.

TTB F 5220.6 (02/2010) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED

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