TTB F 5250.2 (07-2009 version)

OMB NO. 1513-0130 (02/28/2013)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT OF REMOVAL, TRANSFER, OR SALE OF PROCESSED TOBACCO
GENERAL INSTRUCTIONS
A. Who must file this report? (1) A person

holding a permit as a manufacturer of
processed tobacco or of tobacco products
who removes processed tobacco for
shipment to someone who does not hold a
TTB permit as a manufacturer of processed
tobacco, a manufacturer of tobacco products,
or an export warehouse proprietor must
report such removal using this form. (27 CFR
40.522(d)) (2) A person holding a permit as
an importer of processed tobacco or of
tobacco products who transfers or sells
processed tobacco to someone other than a
person holding a TTB permit as an importer
or manufacturer of processed tobacco or
tobacco products or as an export warehouse
proprietor must report such sale or transfer
using this form. (27 CFR 41.262(d))
B. When must I file this report? You must
file this report by the close of the business
day following the removal, sale or transfer,
as described above.
D. How do I file this form? Send the
completed form to the Director, TTB National
Revenue Center, 550 Main St., Ste. 8002,
Cincinnati, OH 45202-5215
Keep a copy for your records.

SPECIFIC INSTRUCTIONS
E. Item 1 – The Employer Identification
Number is the nine-digit code that the
F.

G.

H.
I.

Internal Revenue Service (IRS) has assigned
to your business.
Item 2 - The TTB permit number is listed
on your TTB permit. For example, a permit to
manufacture processed tobacco would have a
number such as “MP-XX-1234,” where XX is
the 2-letter State abbreviation. If you have
more than one TTB permit, file separate
reports for each.
Item 3 – Each report must have a unique
serial number. The first report of the calendar
year is “1” and each subsequent report should
be numbered in chronological order.
Items 4 and 5 – Show in item 4 the date of
the removal, sale, or transfer. Show in item 5
the date of the report.
Items 6 – Show the name and premises
address as it is shown on your TTB permit.

each); and the net total quantity of tobacco, stated in pounds (such as “500
pounds”).
K. Items 10 through 20 – Enter information as required by the headings. The
information must identify the purchaser of the processed tobacco or recipient,
if there is no purchaser. Records supporting the information submitted on this
report must be maintained, as required under 27 CFR 40.521(c) or 41.261(b).

L. Item 21 – Who may sign this report?
If your
The report must be signed by:
business is a

INSTRUCTIONS - TTB F 5250.2 (07/2009)

(1) You; OR
(2) An individual for whom you have filed an ATF or TTB F
5000.8, Power of Attorney, that grants authority to sign
this report

Partnership

(1) Each partner; OR
(2) The partner who has been given the authority to sign by
the articles of partnership or similar agreement of all the
partners that you filed for this permit; OR
(3) An individual for whom you filed an ATF or TTB F
5000.8, Power of Attorney, that grants Authority to sign
this report

Corporation,
Association,
Limited Liability
Company, or
other business

(1) An individual who has signature authority granted by the
business documents that you filed for this permit; OR
(2) An individual for whom you filed an ATF or TTB F
5000.8, Power of Attorney, that grants authority to sign
this report

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. We use this
information collection to determine your identity, location, extent of operations, eligibility to
engage in operations, and the likelihood that you will conform with Federal laws and
regulations. This information is required from you to obtain or retain a benefit and is
mandatory by law (26 U.S.C. 5712). We estimate that you will spend 2 hours to complete
this form (average burden associated with this collection of information). You may spend
more or less time depending upon your individual circumstances. Address your comments
concerning the accuracy of this burden estimate and suggestions to reduce this burden to:
Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax
and Trade Bureau, Washington, DC 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.

PRIVACY ACT INFORMATION

The following information complies with Section 3 of the Privacy Act of 1974 (5 U.S.C.
552a(e)(3)):
1.

What is TTB’s authority to ask for this information? We require this information
under the authority of 26 U.S.C. 5712. You must provide this information before TTB
decides on whether your permit will be issued.

2.

What is the purpose for this information collection? You must provide this
information so that TTB will be able to determine your identity, location, extent of
operations, and eligibility to engage in operations, and the likelihood that you will
conform with Federal laws and regulations.

3.

How does TTB routinely use this information? We use this information to make
determinations for the purposes described in paragraph 2. Also, if we are not
prohibited by law, we may disclose the information that you provided on this form to
other Federal, State, foreign, or local law enforcement or regulatory agency personnel,
and to members of the public to verify it. Finally, we may disclose this information to
the Justice Department if it appears that false information, which constitutes a violation
of Federal law, has been provided.

4.

What is the effect if I do not supply the information TTB requests? If you fail to
supply this information, then it will delay TTB’s determination as described in paragraph
2. Also, TTB may disapprove your application if you fail to supply the information.

J. Items 7, 8 and 9 – Enter a description of

the type of processed tobacco that was
removed, sold, or transferred (using
descriptions such as “loose cut rag tobacco”);
enter the number and size of transport
containers (such as 20 boxes, 50 pounds

Sole
Proprietorship

OMB No 1513-0130 (02/28/2013)
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

REPORT OF REMOVAL, SALE, OR TRANSFER OF PROCESSED TOBACCO
PART I – PERMIT HOLDER INFORMATION
2. TTB permit number (Read
instruction F):

1. Employer identification number (Read instruction E):

3. Serial number (Read
instruction G):

―
4. Date of removal, sale, or transfer (mm/dd/yyyy):

6. Name and premises address:

5. Date of this report (mm/dd/yyyy):

PART II – TYPE AND QUANTITY OF PROCESSED TOBACCO TRANSFERRED
7. Description of processed tobacco:

8. Number of transporting containers and weight
of processed tobacco in each:

9. Total quantity
transferred (pounds):

PART III – IDENTIFICATION OF PURCHASER
AND OF PERSON DELIVERING PROCESSED TOBACCO
10. Full name of purchaser/recipient of
processed tobacco:

11. Business address of the
purchaser/recipient:

12. Telephone number:

(

13. Destination street address of the processed tobacco (if different than Item 10 – if same, check
box below):

)

―

15. Business phone number at
destination (if same as Item 12
check box below):

(
Same as Item 11

)

―

Same as Item 12

16. Name and address of person picking up the processed tobacco for delivery:

17. Identification (number of driver’s license or other
government-issued picture ID) for person listed
in Item 16:

18. License plate/tag number of vehicle:

19. Did the recipient sign a declaration of the specific purpose for
receipt of this processed tobacco?
Yes

No, Explain:

20. Did the recipient sign declaration that he/she represents
purchaser as agent?
Yes

No, Explain:

PART IV – TRANSFERRING PERMIT HOLDER’S CERTIFICATION

Under penalty of perjury, I declare that I have examined this report and, to the best of my knowledge and belief,
the information presented in this report is true, correct, and complete.
21. Signature

TTB F 5250.2 (07/2009)

22. Title

22. Date Signed