Example Monthly Summary Report under Industry Circular 2004-3

Suggested Monthly Summary Report – Based on Example from TTB Industry Circular 2004–3

Date:

Company Principal Name:

Operating Name (if applicable):

Address of Premises:

Telephone Number:

Registry Number:

Permit Number (if applicable):

MONTHLY SUMMARY REPORT OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES EXPORTED

NAME OF PROPRIETOR_______________	FOR MONTH/YR ENDING________________
ADDRESS OF PREMISES_______________	PERMIT/REGISTRY NO. _________________

 

S/N TTB FORM	DATE OF REMOVAL	TYPE OF EXPORT	DESTINATION	TRANSPORT MODE	AMOUNT OF PRODUCT	AMOUNT OF TAX LIABILITY	PROOF OF EXPORT RECEIVED

Column Descriptions:

• S/N TTB Form – Serial No. of corresponding forms TTB F 5100.11.

• Date of Removal – Date of removal or withdrawal of the products.

• Type of Export – Direct Export, Shipment to Armed Forces, Foreign Trade Zone, Customs Bonded Warehouse, Use as Supplies on Vessels or Aircraft.

• Destination – Destination of products exported.

• Transport Mode – Specify type of transportation used.

• Amount of Product – Specify the amount of products removed using data from the relevant TTB F 5200.14.

• Amount of Tax Liability – Total amount of tax liability on the exported products.

• Proof of Export – Indicate “Y” for yes if proof of export has been received. Indicate “N” for no if proof of export has yet been received.

Additional Instructions:

You must obtain proof of export within 90 days from the date of removal.  If you have not received adequate proof of export within 90 days from the date of removal, you must pay applicable taxes, plus interest, and make an adjusting entry on your next Excise Tax Return, Form 5000.24.  If you are late in paying or fail to pay taxes and interest, we may impose additional penalties and interest. Three months after the first submission of the Monthly Report of Goods Exported, you must resubmit the summary report showing that you received proof of export for each entry or that you made payment on Form 5000.24.  The individual submitting this report must have signing authority on file with TTB.