Form TTB F 5120.25 TTB F 5120.25 Application to Establish and Operate Wine Premises

OMB No. 1513-0009
1.

SERIAL NUMBER

DEPARTMENT OF THE TREASURY
2. DATE

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

APPLICATION TO ESTABLISH AND OPERATE WINE PREMISES
3. REGISTRY NUMBER (Leave blank if

(See Instructions on next page)

new applicant)

4. TO: DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
550 Main St., Ste 8002, Cincinnati, OH 45202-5215

5. APPLICATION IS MADE TO OPERATE (Check one only)

6.

7.

NAME AND PRINCIPAL BUSINESS ADDRESS OF APPLICANT
(Name and street, city, county, State, and ZIP Code)

PHONE #

BONDED
WINERY

BONDED WINE
CELLAR

TAX PAID WINE
BOTTLING HOUSE

ADDRESS (Address where wine operations will occur.)
(If different from address in Item 6)

PHONE #

EIN#

8. PURPOSE FOR WHICH FILED (Such as original establishment, trade name change, alteration of premises)

Original:

New Premises or change in Proprietorship

Amended for:

Change in Location

Change in Control (Date_/_/_)

Change in information on
application
Change in Officers

Change in Name of Proprietor
or Trade Name

Alternating Proprietorship with:
Alternating Premises with:
Other: Please Specify

9. APPLICATION FORM AND ATTACHED STATEMENTS AND DOCUMENTS SHOWING REQUIRED INFORMATION IN ITEMS 1-8 ON REVERSE OF FORM
This application includes: (1) this form; (2) the papers and documents which are being submitted for the first time, and which̀ are listed in Items 9A
and 9B; (3) the current papers and documents from the latest approved TTB F 5120.25 Serial No.
, which are listed in Items 9A-1 and 9B-1;
and (4) the supporting organizational documents filed in connection with another establishment but incorporated in this application by reference,
and listed below in Item 9C.
9A.NUMBER OF PAGES ATTACHED TO THIS FORM ( )
9A-1. PAGES FROM CURRENT APPROVED TTB F 5120.25 THAT REMAIN
PAGE NUMBERS
9B. ORGANIZATIONAL DOCUMENTS SUBMITTED WITH THIS FORM
(List each document)

PAGE NUMBERS
9B-1. ORGANIZATIONAL DOCUMENTS FILED WITH PRIOR
APPROVED TTB F 5120.25 (List each document)

9C. ORGANIZATIONAL DOCUMENTS FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT BUT INCORPORATED IN THIS APPLICATION BY
REFERENCE (List each document, and show the name or plant number under which filed)

NO WINE MAY BE PRODUCED OR UNTAXPAID WINE RECEIVED UNTIL THE PREMISES AND OPERATIONS ARE APPROVED BY THE DIRECTOR,
NATIONAL REVENUE CENTER.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS APPLICATION AND, TO THE BEST OF MY KNOWLEDGE AND
BELIEF, IT IS TRUE, CORRECT, AND COMPLETE.
10. SIGNATURE
11. TITLE

FOR TTB USE ONLY
APPLICATION IS

EFFECTIVE DATE
APPROVED

SIGNATURE OF DIRECTOR, NATIONAL REVENUE CENTER

TTB F 5120.25 (03/2016)

DISAPPROVED
DATE

GENERAL INSTRUCTIONS
1. Each person desiring to conduct the operations of a bonded wine cellar, a
bonded winery, or a taxpaid wine bottling house must file this application, in
duplicate, with the Director, National Revenue Center, Alcohol and Tobacco
Tax and Trade Bureau (TTB), at the address in Item 4.

3.

DISCLOSURE. If this application is not for a bonded wine premises in which
production operations will be conducted and, thus a Federal Alcohol
Administration Act basic permit is not required, would you agree to the listing
of your name in a TTB publication which may be distributed to the general
public upon request? A “no” response will have no effect on the consideration
of this application. Under 26 U.S.C. 6103, you have a legal right not to give
this release.

4.

TRADE NAME. List each trade name to be used in connection with the wine
operations. If State or local law requires registration, certify that each trade
name is registered. State the operating name if other than the name in Item 6.
If a trade name is listed in any basic permit issued, such trade name is not
required to be included in this application.

5.

SPIRITS OPERATIONS. Describe any operation which will involve the use
of spirits.

4. If this application is for a taxpaid wine bottling house, you will not conduct
spirits operations or need a bond, so paragraphs 6 and 7 of the specific
instructions are not applicable.

6.

BONDS AND PERMITS. With respect to this application, list all basic permits
and bonds (including those filed with this application) showing the name and
the surety for each bond.

5. Applications must be submitted in accordance with the instructions on
this form and in 27 CFR Part 24. Incomplete applications will be returned
to the applicant without action.

7.

VOLATILE FRUIT-FLAVOR CONCENTRATE OPERATIONS. For volatile
fruit-flavor concentrate producers, submit a step-by-step description of the
production process, commencing with obtaining the juice through each step
of the process to removal of the concentrate from the system. For production
of high-proof concentrate (more than 24 percent alcohol), indicate any step in
the process at which the spirits are potable. Include the maximum quantity in
gallons of fruit must and volatile fruit-flavor concentrate produced in 24
hours; the maximum and minimum fold; and the maximum percent of alcohol
in the concentrate for each kind of fruit used.

8.

OTHER OPERATIONS. Describe any other operations not specifically
authorized by Part 24 that are to be conducted on the wine premises. This
must include a list of the premises and any major equipment used, and a
statement as to the relationship, if any, of the operation to the wine operations.
These other operations need not be restricted to alcohol-related businesses.

2. The application information required will be on letter-sized paper with each
attached page identified with the name of the applicant, the serial number of
the application and the number of the page.
3. The proprietor is responsible for keeping information of an approved
application current and complete. When required by 27 CFR Part 24, the
proprietor must submit an amended application with supplemental or
replacement pages or other documents necessary to update the previously
approved application. Replacement pages must be numbered to correspond
to the pages being replaced.

SPECIFIC INSTRUCTIONS
Item 1. SERIAL NUMBER. Applications on this form must be serially numbered,
commencing with serial number 1 for original establishment, and
continuing in sequence for each subsequent application. Applications for
a taxpaid wine bottling house will be filed separately and likewise begin
with serial number 1.
Items 6 & 7. NAME AND ADDRESS. The address must be stated as explicitly as
possible with a ZIP Code. If located in a city, the numbered street
address and the name of the city will be given. If a rural address, give
the name of the county and nearest post office, with the approximate
distance and direction there from, including the name or number of
the road or highway on which situated.
ATTACHED STATEMENTS AND DOCUMENTS
1.

BUSINESS ORGANIZATION. If a statement is already on file with TTB for
another authorization, only reference that authorization by name, address,
and registry number per 27 CFR 24.109(k). Attach a statement, if not already
on file, showing the type of business organization (e.g., sole owner,
partnership, corporation, limited liability company) and the persons having
an interest in the business supported by the following:

For corporations or limited liability companies:
(a)
(b)
(c)
(d)

(e)

Charter or certificate of existence, incorporation, or organization,
Names and addresses of officers, directors, members and managers.
Certified extracts of minutes authorizing certain individuals to sign.
Statement showing the number of shares/ownership of each class of stock/
interest authorized and outstanding, and the voting rights of the respective
owners or holders.
Statement of interest: Names and addresses of the 10 persons having the
largest ownership or other interest and nature and amount of the
stockholding or other interest of each, whether the interest appears in the
name of the interested party or in the name of another party. The Director,
National Revenue Center may request the names of interested persons if
the applicant corporation or LLC is wholly owned or controlled by another
corporation or LLC.

For partnerships:
True copies of articles or partnership agreement, if any, and of the
certificate of partnership where required to be filed by local authority.
2.

WINE PREMISES. Describe each tract of land comprising the wine
premises. Description must be by directions and distances, in feet and inches,
with sufficient particularity to enable ready examination of the boundary of the
wine premises. Describe the means employed to afford security of the wine
premises. Describe where and how any taxpaid wine will be stored on the
premises and the means used to segregate and identify taxpaid wine from
untaxpaid wine. Describe any alternating areas. Each wine premises building
must be described as to size, construction, and use. Buildings not used for the
wine operations must be described only as to size and use. If wine premises
consists of a partial building, rooms or floors, each must be described
separately. Means of ingress and egress from the wine premises to adjoining
portions must be described.
(a) If operating a bonded winery or bonded wine cellar in a residential building,
describe how the bonded premises are segregated from the residence and
what direct access to the bonded premises is available.

PRIVACY ACT INFORMATION
The following information is provided pursuant to Section 3 of the Privacy Act of
1974 (5 U.S.C. 552a(e)(3)):
1.

AUTHORITY. Solicitation of this information is made pursuant to 26
U.S.C. 5356. Disclosure of this information by the applicant is mandatory if
the applicant wishes to obtain authorization for operating a bonded wine
cellar, a bonded winery, or a taxpaid wine bottling house.

2.

PURPOSE. To identify the applicant, to identify the nature, location, and
the extent of the premises, the specific type or types of operations to be
conducted on the premises, and to determine the eligibility of the applicant
to register the wine premises.

3.

ROUTINE USES. The information will be used by TTB to make
determinations set forth in paragraph 2. In addition, the information may be
disclosed to other Federal, State, foreign, and local law enforcement and
regulatory agency personnel to verify information on the form where such
disclosure is not prohibited by law. The information may further be disclosed
to the Justice Department if it appears that the furnishing of false information
may constitute a violation of Federal law. Finally, the information may be
disclosed to members of the public in order to verify the information on the
form where such disclosure is not prohibited by law.

4.

EFFECTS OF NOT SUPPLYING REQUESTED INFORMATION. Failure to
supply complete information will delay processing and may result in the
denial of the application.
PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. This
information collection is required by 26 U.S.C. 5356, and is used by TTB to
determine if the applicant is eligible to receive a wine premises permit. The
information is required to obtain a benefit.
The estimated average burden associated with this collection of information 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 addressed to Reports Management Officer,
Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau,
1310 G Street, NW., Box 12, 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.

(b) If in an alternating proprietorship arrangement, provide a copy of the
alternation agreement showing that each proprietor will conduct
independent operations.
TTB F 5120.25 (03/2016)