Form TTB F 5120.24 TTB F 5120.24 Drawback on Wines Exported

(c) vessel of the United States engaged in trade between Atlantic and Pacific ports of the United States; (sel employed in

country (1) the fisheries: or (2) the wd) veshaling business. Sh of vessel, location of operations. If aircraft, show also name of ^{airline and country of registry of aircraft. 4}Show filing date when

use of such date has been authorized in lieu of serial numbers o

TTB F 5120.24 (8/2006)

(Name)

OMB No. 1513-0016

1. SERIAL NUMBER (The exporter will number each form beginning with "1" each January 1.)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

DRAWBACK ON WINES EXPORTED

(See instructions below)

(FOR TTB USE ONLY)

PART I - NOTICE

2. TO

Director, National Revenue Center / Alcohol and Tobacco Tax and Trade Bureau 550 Main St., Ste 8002

CincinnatI, OH 45202-5215

The undersigned gives notice of the shipment of wines manufactured , bottled, or packaged in the United States

on which drawback of the Internal Revenue tax paid or determined is claimed.

CLAIM NUMBER

3. EXPORTER - NAME AND ADDRESS (Number, Street, City, State, Zip Code

4. Permit/Registry Number

DATE RECEIVED

TTB F 5620.4

FILED WITH CLAIM NO.²

5. EMPLOYER IDENTIFICATION NUMBER

SHIPMENT FOR EXPORT TO ARMED FORCES OF THE U.S.

TRANSFER TO

(Number)

AMOUNT CLAIMED

$

(Location)

6. PURPOSE

FOREIGN TRADE

OF SHIPMENT

(Make applicable entries)

ZONE

AMOUNT REJECTED

EXPORTATION TO (Name of foreign port and country)

$

AMOUNT APPROVED

USE AS SUPPLIES ON

A VESSEL³

AIRCRAFT³

CLAIMS CLERK

3257 DIRECTOR OF CUSTOMS AT PORT OF

7. CONSIGNED TO OR IN CARE OF

(Make applicable entries)

8. NAME OF DOMESTIC CARRIER

TRANSPORTATION OFFICER

(Name)

(Location)

CUSTOMS OFFICER IN (Number)

9. NAME OF EXPORT CARRIER

(Location)

CHARGE OF FOREIGN TRADE ZONE

10. DESCRIPTION OF WINE SHIPPED

PART II - CLAIM

(c) vessel of the United States engaged in trade between Atlantic and Pacific ports of the United States; (d) vessel employed in country of registry, and ports of call, or if a whaling vessel, location of operations. If aircraft, show also name of airline and country of registry of aircraft.

⁴ Show filling date when use of such date has been authorized in lieu of serial numbers on cases.

¹Insert, as applicable, plant number of distilled spirits plant, registry number of bonded wine cellar or taxpaid wine bottling house, or number of the wholesale liquor dealers permit issued under the Federal Alcohol Administration Act.

²Complete only for consolidated claims; show serial number of last claim tabulated.

³State whether a (a) vessel or aircraft operated by the United States; (b) vessel or aircraft engaged in foreign trade, or in trade between the United States and any of its possessions, or between Hawaii or Alaska and any other part of the United States;

TTB F 5120.24 (07/2016) )

Page 1 of 2

The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded within the limits of the United States. The kind, quantity, and description of the wines stated in Part I is correct, and I am

justly entitled to drawback of the tax in the amount claimed herein. Internal Revenue tax equal to such amount has been paid or determined as provided by law and regulations. No other claim for allowance of drawback has been made under 26

U.S.C. 5062(b), or Section 309 of the Tariff Act of 1930, as amended, on these wines or any part thereof. Under penalties of perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the statements herein and in Part I, are true, correct, and complete.

11. AMOUNT CLAIMED

$

12. I REQUEST DRAWBACK ALLOWED TO BE PAID BY

CHECK

CREDIT

13. DATE

4. EXPORTER

D. SIGNATURE

14b. TITLE

KIND OF WINE

(a)

NUMBER OF PACKAGES

(b)

CASES

SERIAL NUMBERS OF CONTAINERS OR CASES⁴

(f)

ALC. CONTENT

(g)

TOTAL WINE GALLONS

(h)

DRAWBACK RATE PER WINE

GALLON

(i)

NUMBER

(c)

BOTTLES

in case

(d)

size

(e)

CTION ACT NOTICE

This request is in accordance with Paperwork Reduction Act of 1995. This information collection is used to obtain drawback of taxes on wine exported from the United States. The

information is required to obtain a benefit under 26 U.S.C. 5062.

The estimated average burden associated with this collection of information is 1 hour and 7 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, D.C. 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 5120.24 (7/2006)

PAPERWORK REDU

1. GENERAL. Under 27 CFR 28.212 and 28.214 persons qualified as proprietors of distilled spirits plants, bonded wine cellars, or taxpaid wine bottling houses, or holding wholesale liquor dealer permits issued under the Federal Alcohol Adminstration Act, are authorized to file claims on Form 5120.24 for allowance of drawback of Internal Revenue taxes.

2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy, marked “Consignee’s Copy,” where the wine is for use on an aircraft.

3. INSTRUCTIONS TO EXPORTER. Complete Part I and execute Part II. If you are a proprietor of a bonded wine cellar, you may elect (item 12) to have a drawback allowance paid either by check or by credit (TTB F 2639), which can be claimed on a subsequent

tax return on Form 5000.24; all other claimants should check the box designated “Check”. On shipments of the wine, forward the original and one copy of this form to the official designated in Item 7, forward one copy to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau

at the address shown in item 2, and retain a copy in your files. If a “Consignee’s Copy” has been prepared (see instruction 2), forward it to the airline company at the airport.

4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other Than Fishing Vessels. After inspection of lading, the Customs officer must execute Part IV, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the copy for his/her files. (b) Use on Aircraft and Fishing Vessels. After inspection of lading, the Customs officer must execute Part III on both copies

20 and 27,

PART III - CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT

I hereby certify that the wines described in Part I were found as described, except as noted in Item 19, and that the wines were--

19.

INSPECTION DISCLOSED NO EVIDENCE OF TAMPERING

DISCREPANCIES

OR SHORT SHIPMENT AS FOLLOWS:

NO DISCREPANCY

PART IV - CUSTOMS OFFICER’S PORT REPORT OF THROUGH SHIPMENT AT FRONTIER PORT

26. NATURE AND EXTENT OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.

PART V - CERTIFICATE OF CLEARANCE OR USE

30. THE EXPORTING CONVEYANCE BEARING THE WINES DESCRIBED IN ITEM 10, WITH EXCEPTIONS AS NOTED ABOVE --

PART VI - CERTIFICATE RECEIPT BY ARMED FORCES OFFICER

The wine described in Part I, with exceptions as noted in item 35, were received for export to the Armed Forces of the United States. The wines will not be shipped for consumption or used in any place subject to the application of the Internal Revenue laws of the United States.

INSTRUCTIONS

1. GENERAL. Under 27 CFR 28.212 and 28.214 persons qualified as proprietors of distilled spirits plants, bonded wine cellars, or taxpaid wine bottling houses, or holding wholesale liquor dealer permits issued under the Federal Alcohol Administration Act, are authorized to file claims on Form 5120.24 for allowance of drawback of Internal Revenue taxes.

2. NUMBER OF COPIES. Prepare this form in quadruplicate, except prepare a fifth copy, marked “Consignee’s Copy,” where the wine is for use on an aircraft.

3. INSTRUCTIONS TO EXPORTER. Complete Part I and execute Part II. A proprietor may elect (in item 12) to recoup an approved drawback allowance by check or credit. A check or ACH electronic payment will be issued if the "Check" box is marked. An approved credit can be taken as a decreasing adjustment on one or more Excise Tax Returns (Form 5000.24). On shipments of the wine, forward the original and one copy of this form to the official designated

in Item 7, forward one copy to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain a copy in your files. If a “Consignee’s Copy” has been prepared (see instruction 2), forward it to the airline company at the airport.

4. ACTION BY CUSTOMS. (a) Shipment for Direct Exportation, or Use on Vessels Other Than Fishing Vessels. After inspection of lading, the Customs officer must execute Part IV, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the copy for his/her files. (b) Use on Aircraft and Fishing Vessels. After inspection of lading, the Customs officer must execute Part III on both copies

and forward them to the Port Director of Customs. The Port Director, on receipt of the required ”Certificates of Use” (for aircraft) or Customs Form 5125 (for fishing vessels), must execute Part V, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade

Bureau at the address shown in item 2, and retain the copy for his/her files. (c) Lading at Interior Port For Exportation Through Frontier Port. On completion of lading, the Customs officer

will affix the seals, then execute Part III on both copies and forward them to the Port Director of Customs at the interior port of lading for forwarding to the Customs officer at the frontier port. That officer, when satisfied that the shipment has been exported, must execute Part IV on both copies and return them to the Port Director of Customs at the interior port.

The Port Director will then execute Part V, forward the original to the Director, NRC,

Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the copy for his/her files. (d) Receipt in Foreign Trade Zones. On receipt of the wine, the Customs officer must execute Part III on both copies, forward the original to the Director, NRC,

Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the copy for his/her files.

5. ACTION BY ARMED FORCES OFFICER. On receipt of the wines, the officer to whom consigned (or other authorized supply officer) must execute Part VI on both copies, forward the original to the Director, NRC, Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 2, and retain the copy for his/her records.

RETENTION PERIOD: The retention period is three years from the record date or the date of the last entry required to be made on the record, whichever is later. The appropriate TTB officer may require records to be kept an additional period not to exceed three years.

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with Paperwork Reduction Act of 1995. This information collection is used to obtain drawback of taxes on wine exported from the United States. The information is required to obtain a benefit under 26 U.S.C. 5062.

The estimated average burden associated with this collection of information is 1 hour and 7 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, 1310 G Street, NW., Box 12, Washington, D.C. 200005.

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 5120.24 (07/2016) )

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34. DATE

35. DISCREPANCIES

36. SIGNATURE

37^{. RANK}

38. TITLE

CLEARED FROM THE PORT OF

ON (Date)

BOUND FOR (Foreign port)

31. THE WINE HAS BEEN USED AS SUPPLIES ON THE FISHING VESSEL OR AIRCRAFT IDENTIFIED ABOVE, AND THE EVIDENCE OF SUCH USE HAS BEEN RECEIVED.

32. DATE

33^{. SIGNATURE OF PORT DIRECTOR OF} CUSTOMS

27. The exporting conveyance noted in Item 15, bearing the wines described in Item 10, ^{with exceptions as noted in items} 19 and 26, ^{cleared from this port for the port of}

FOREIGN PORT

28. DATE

29. ^{SIGNATURE AND TITLE OF CUSTOMS OFFICER}

23. FRONTIER PORT

24. DATE RECEIVED

25. INSPECTION DISCLOSED:

NO EVIDENCE OF TAMPERING

SEALS INTACT

SEALS BROKEN

20. DATE

21^{. PORT}

22. SIGNATURE AND TITLE OF CUSTOMS OFFICER

15. LADEN FOR

VESSEL (Name)

AIRCRAFT (Name, symbols, number)

EXPORT

USE AS SUPPLIES

RAILROAD CAR (Number)

TRUCK (State license)

ON BOARD

16. ^{RECEIVED IN NUMBER}

17. SHIPPED TO ^{(Frontier Port)}

^18. SERIAL NUMBER OF SEALS USED

FOREIGN TRADE ZONE