Form F 5110.75 F 5110.75 Alcohol Fuel Plant Report

Form Approved: OMB No. 1513-0052 (02/28/2013)
1. PERMIT NUMBER

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

ALCOHOL FUEL PLANT REPORT
GENERAL INSTRUCTIONS
1. Each proprietor of an Alcohol Fuel Plant (AFP) must file this
annual report of plant operations. A report is due even if no
operations were conducted during the period.

4. Report is due by January 30th following the end of the calendar year.
5. Report spirits in proof gallons and alcohol fuel in wine gallons.
Round to the nearest whole number.

2. Prepare in duplicate. Send the original to the Director, National
Revenue Center, Alcohol and Tobacco Tax and Trade Bureau,
550 Main St, Ste 8002, Cincinnati, OH 45202-5215. Keep the
copy with your AFP records for 3 years.

6. Small and medium plants complete Part I and II. Large plants
complete Parts I and III.

3. Proprietors will prepare and file a report once a year to cover all
operations for the calendar year.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used to monitor and audit the operations of alcohol
fuel plants and to collect statistics regarding the production and use of alcohol for fuel use. The information required is mandatory by statute (26 U.S.C. 5207).
The estimated average burden associated with this collection of information is 1 hour and 6 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, D.C. 20220, and the Office of
Management and Budget, Paperwork Reduction Project (1513-0052), Washington, D.C. 20503.
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.
PART - I
1. REPORT FOR CALENDAR YEAR__________________________
2. TYPE OF PLANT

SMALL

MEDIUM

LARGE

3. NAME OF PROPRIETOR (If partnership, include name of each partner)

4. LOCATION (If no street show rural route)

PART - II
FOR SMALL AND MEDIUM PLANTS ONLY
SPIRITS7RANSACTIONS
1. PR2'UCED

PROOF GALLONS

2. RECEIVED
3. 5ECEIVED FROM CUSTOMS CUSTODY (Medium plants only)
4. 8SED ON PREMISES FOR FUEL (Do not include fuel alcohol)
5. 8SED IN MAKING FUEL ALCOHOL
6. DESTROY(D
7. TRANSFE5RED
FUEL ALCOHOL TRANSACTIONS 
8. PRO'UCED (Rendered Unfit)

 WINE GALLONS

9. 8SED ON PREMISES FOR FUEL
10. TRANSFERRED
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is a true and complete report of
operations.
11. SIGNATURE

TTB F 5110.75 (0/20)

12. DATE

Page 1 of 2

PART - III
FOR LARGE PLANTS ONLY
Report the loss (line 12) or the gain (line 4) of spirits found by taking the required physical inventory for the reporting period. Report any losses by theft
separately (line 11).
 SPIRITS 7RANSACTIONS 
1.2N HAND BEGINNING OF REPORTING PERIOD

PROOF GALLONS

2. PRO'UCED BY DISTILLING
3.5ECEIVED FROM OTHER PLANTS
4. INVENT2RY GAIN
5. ,MPORTED SPIRITS RECEIVED FROM CUSTOMS CUSTODY
6.
7. TO7AL (lines 1 through 6)
8. 8SED IN MAKING FUEL ALCOHOL
9. 8SED ON PLANT PREMISES FOR FUEL (Do not include fuel alcohol)
10. USED AS DISTILLING MATERIAL OR FOR REDISTILLING
11. LOST BY THEFT
12. INVENTORY LOSS
13. TRANSFERRED TO OTHER PLANTS
14. DESTROYED
15.
16. TOTAL (lines 8 through 15)
17. ON HAND END OF PERIOD (Subtract line 16 from line 7)

18. MANUFACTURED

FUEL ALCOHOL TRANSACTIONS

WINE GALLONS

19. DISTRIBUTED OR SOLD FOR FUEL PURPOSES
20. RECEIVED FROM CUSTOMS CUSTODY
21. USED ON PLANT PREMISES FOR FUEL PURPOSES
22. DESTROYED
23. ALL OTHER DISPOSITIONS
24. REMARKS

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

26. DATE

Page 2 of 2

TTB F 5110.75 (0/20)