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pdfOMB No. 1513-0035
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
AUDITED BY
INVENTORY - EXPORT WAREHOUSE PROPRIETOR
DATE OF AUDIT
(Prepare in Duplicate)
1. NAME OF PROPRIETOR
2. ADDRESS OF WAREHOUSE (Number, Street, City, State, and ZIP Code)
3. PERMIT NUMBER
EW ―
4. TYPE OF INVENTORY (Check applicable box)
COMMENCING
CONCLUDING
5. DATE OF INVENTORY
SPECIAL
6. ARTICLES IN INVENTORY * Enter quantity in pounds and fractions of a pound rounded to 2 decimal places.
LARGE CIGARS
(Number)
(a)
SNUFF
(Pounds)*
(f)
SMALL CIGARS
(Number)
(b)
PIPE TOBACCO
(Pounds)*
(g)
LARGE CIGARETTES
(Number)
(c)
ROLL-YOUR-OWN
TOBACCO
(Pounds)*
(h)
SMALL CIGARETTES
(Number)
(d)
CIGARETTE
PAPERS
(Number)
(i)
CHEWING TOBACCO
(Pounds)*
(e)
CIGARETTE
TUBES
(Number)
(j)
PROCESSED
TOBACCO
(Pounds)*
(k)
Under the penalties of perjury, I declare that this inventory includes all cigars, cigarettes, chewing tobacco, snuff, pipe tobacco, rollyour-own tobacco, cigarette papers, cigarette tubes, and processed tobacco required to be accounted for and is, to the best of my
knowledge and belief, true and accurate.
7. SIGNATURE (Print name of individual signing the form)
8. DATE
9. TITLE OR STATUS (State whether individual owner, member of firm, or if officer of corporation, give title)
TO BE EXECUTED ONLY WHEN INVENTORY IS VERIFIED BY TTB OFFICER. I have examined the cigars, cigarettes, chewing
tobacco, snuff, pipe tobacco, roll-your-own tobacco, cigarette papers or tubes, and processed tobacco reported in this inventory, and I
am satisfied that the inventory is accurate.
10. SIGNATURE OF TTB OFFICER
11. TITLE
12. DATE
TTB F 5220.3 (04/2016) VERSIONS PREVIOUS TO 02/2010 ARE SUPERSEDED AND MAY NOT BE USED.
INSTRUCTIONS
WHEN REQUIRED: Each export warehouse proprietor is
required by regulation to make a true and accurate inventory at
the time of commencing business, at the time of concluding
business, and at other times when required by the appropriate
TTB officer (27 CFR Part 44). Such inventories must be made
and the date entered in item 5 of this form as the DATE OF
INVENTORY as follows:
3. SPECIAL INVENTORY -- To be made whenever required by
1. COMMENCING INVENTORY -- To be made as of the date
of commencing business (which will be t he effective date of
the p ermit); at the time of transferring ownership; and at the
time of changing location of the factory.
ITEMS TO BE INCLUDED: All inventories must include all
tobacco products, cigarette papers, cigarette tubes, and
processed tobacco. 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. CONCLUDING INVENTORY -- To be made as of the close
of business on the date the business is concluded, including
transfer of ownership, and including a change of location. If a
fiduciary takes over the business for liquidation and files a
statement and extension of coverage of the proprietor’s bond,
as provided by regulation, no concluding inventory is
necessary until the fiduciary liquidates the business. The
DATE OF INVENTORY will be the date the permit is
surrendered, or in the case of transfer of ownership, the date
preceding the change.
any TTB officer. If an inventory is made as of the beginning
of business on any day, that date must be entered as the
DATE OF INVENTORY. If the inventory is made as of the
close of business on any day, it will be considered as made
at the beginning of business of the next calendar day, and
that date must be entered as the DATE OF INVENTORY.
PREPARATION AND DISPOSITION: The inventory must be
prepared in duplicate by the proprietor. The original must be
submitted to the:
National Revenue Center,
550 Main St, Ste. 8002,
Cincinnati. OH 45202-5215.
A duplicate copy must be retained by the proprietor
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 a basis for verification of tax liability. This form is subject to TTB inspection. Completion of this form is
mandatory (26 U.S.C. 5721 and 5741.
The estimated average burden associated with this collection of information is 5 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, 1301 G Street, NW., Box 12, Washington DC 20005.
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 5220.3 (04/2016) VERSIONS PREVIOUS TO 02/2010 ARE SUPERSEDED AND MAY NOT BE USED.
File Type | application/pdf |
File Title | Microsoft Word - TTB F 5220.3 CHIPRA.doc |
Author | maWood |
File Modified | 2016-04-13 |
File Created | 2009-05-22 |