Form TTB F 5100.12 TTB F 5100.12 Specific Exportation Bond – Distilled Spirits or Wine Wi

OMB No. 1513-0031

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

SPECIFIC TRANSPORTATION BOND - DISTILLED SPIRITS OR WINES WITHDRAWN FOR
TRANSPORTATION TO MANUFACTURING BONDED WAREHOUSE - CLASS SIX
(File in duplicate. See instructions below.)

ADDRESS (Number, street, city, State, and ZIP Code)

PRINCIPAL

AMOUNT OF
BOND

SURETY (IES)

WAREHOUSE NUMBER

EFFECTIVE DATE

LOCATION OF WAREHOUSE (Number, street, city, State and ZIP Code)

NUMBER
APPLICATION MADE TO WITHDRAW FROM
Distilled Spirits Plant
Bonded Wine Cellar
LOCATED AT (Number, street, city, State, and ZIP Code)

PROPRIETOR
APPLICATION MADE TO WITHDRAW
q Distilled spirits
q Wines

KNOW ALL MEN BY THESE PRESENTS, that we, the above-named principal and surety (or sureties), are held and firmly bound unto the United States of
America in the above amount, lawful money of the United States; for the payment of which we bind ourselves, our heirs, executors, administrators, successors,
and assigns, jointly and severally; firmly by these presents.
This bond must not in any case be effective before the above-named date, but if accepted by the United States it must be effective according to its terms on
and after that date without notice to the obligors: provided, that if no date is inserted in the space above provided therefore, the date of execution must be the
effective date.
WHEREAS, the principal is the proprietor of the Manufacturing Bonded Warehouse identified above, established and bonded under the provisions of Chapter 51 of
Title 26 of the United States Code and of the Tariff Act of 1930, as amended; and
WHEREAS, the principal has made application to withdraw from the distilled spirits plant or bonded wine cellar specified above, the following described distilled
spirits or wines, without payment of tax, for transportation to and deposit in the Manufacturing Bonded Warehouse:
NUMBER OF PACKAGES
& KIND OF LIQUORS

MARKS AND SERIAL NUMBERS OF CONTAINERS
BARRELS, CASES, TANK CARS, ETC.

WINE
GALLONS

PROOF
GALLONS

AMOUNT OF
TAX

NOW, THEREFORE, the conditions of this bond are such that - 1. If the distilled spirits or wines so withdrawn are duly transported to and deposited in the manufacturing bonded warehouse aforesaid, as required by law and
regulations; and
2. If the principal has, as to such distilled spirits or wines, or any part thereof, not so transported and deposited, or otherwise lawfully disposed of or accounted
for, paid to the United States the tax imposed thereon by law now or hereafter in force, together with penalties and interest;
Then this obligation is to be null and void, but otherwise to remain in full force and effect.
We, the obligors, for ourselves, our heirs, executors, administrators, successors, and assigns, do further covenant and agree that upon the breach of any of the
covenants of this bond, the United States may pursue its remedies against the principal or surety independently, or against both jointly, and the said surety hereby
waives any right or privilege it may have of requiring, upon notice, or otherwise, that the United States must first commence action, intervene in any action of any
nature whatsoever already commenced, or otherwise exhaust its remedies, against the principal.
WITNESS our hands and seals this

day of

,20

Signed, sealed, and delivered in the presence of -

SEAL
SEAL
SEAL
SEAL
SEAL
SEAL
TTB F 5100.12 (01/2009)

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FOR TTB USE ONLY
On behalf of the United States, I approve the foregoing bond which has been executed in due form and in compliance with the law, regulations, and instructions.
SIGNATURE OF DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND TOBACCO
TAX AND TRADE BUREAU

DATE APPROVED

INSTRUCTIONS
(For regulatory provisions concerning TTB 5100.12, see
Subpart D of 27 CFR Part 28.)
1. This bond must be filed in duplicate with the Director, National Revenue
Center, Alcohol and Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002,
Cincinnati, OH 45202-5215.
2. The name, including the full given name, of each party to the bond must
be written in the heading thereof, and each party must sign the bond with his/her
signature, or the bond may be executed in his/her name by a duly empowered
attorney-in-fact.
3. In the case of a partnership, the duly authorized trade name of the firm,
followed by the names of all the members thereof, must be given in the
heading. In executing the bond, the firm name must be typed or written
followed by the word "by" and the usual signatures of all partners, or the
signature of any partner duly authorized to sign the bond on behalf of the
firm, or by a duly empowered attorney-in-fact.
4. If the principal is a corporation, the heading must give the corporate
name, the name of the State under the laws of which it is organized, and the
location of the principal office; and the bond must be executed in the corporate name, immediately followed by the signature and title of the person duly
authorized to act in its behalf.
5. If the bond is signed by an attorney-in-fact for the principal, or by one of
the members for a partnership or association, or by an officer or other person for a corporation, there must be filed with the bond a duly authenticated
copy of the power of attorney, resolution of the board of directors, excerpt of
the bylaws, or other document, authorizing the person signing the bond to
execute it on behalf of the principal, unless such authorization has been
previously filed with the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau, in which event a statement to such effect
must be attached to the bond.

6. The signature for the surety must be attested under corporate seal. The
signature for the principal, if a corporation, must also be so attested if the
corporation has a corporate seal. If the corporation has no seal, that fact
should be stated. Each signature must be made in the presence of two
witnesses (except where corporate seals are affixed), who must sign their
names as such.
7.
bond may
may be
be given
given with
surety
7. AAbond
with corporate
corporatesurety
suretyauthorized
authorizedtotoact
actasas
surety
by
of of
collateral
security.
by the
the Secretary
Secretaryofofthe
theTreasury,
Treasury,ororbybydeposit
deposit
collateral
security. Only
consisting
bonds or notes
the United
States.
The Act and
of July
30, 1947
public debtofobligations
of theofUnited
States,
the principal
interest
of
(section
15,
title 6, U.S.C.) guaranteed
provides thatby"the
notes of the
which
are
unconditionally
thephrase
United'bonds
Statesor
Government,
United States' must be deemed to mean any public debt obligations of the
are acceptable as collateral security (31 U.S.C. 9301, 9303). A list of
United States and any bonds, notes, or other obligations which are unconsecuritiesguaranteed
acceptableas
astocollateral
in lieu
of principal
surety bonds
available
from
ditionally
both interest
and
by theisUnited
States."
the Bureau of the Public Debt, Office of the Commissioner, Government
Securities Regulations Staff.
8. If any alteration or erasure is made in any bond before the execution
thereof, there must be incorporated in the bond a statement to that effect by
the principal and surety or sureties; or if such alteration or erasure was made
after the bond was executed, the consent of all parties thereto must be
written in the bond.
9. The penal sum named in the bond must be in accordance with 27 CFR
Part 28.
10. After approval of the bond, a copy must be returned to the principal.
11. All correspondence regarding this bond should be addressed to the
Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau.
The
retention
period
is 2 years.
The record
record retention
period
is 2 years.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of
1995. The purpose of this information collection is to protect
Federal excise taxes. The information is used to determine
compliance by payment on taxpaid commodities. The information
requested is mandatory by statute (19 U.S.C. 1311).
The estimated average burden associated with this collection of
information is 1 hour 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, 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.

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TTB F 5100.12 (01/2009)