TTB F 5620.8 Claim -- Alcohol, Tobacco, and Firearms Taxes

OMB No. 1513-0030 (xx/xx/xxxx)
FOR TTB USE ONLY

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

CLAIM -- ALCOHOL, TOBACCO, AND FIREARMS TAXES

CLAIM NUMBER

(File in duplicate with the Alcohol and Tobacco Tax and Trade Bureau)

1. THIS CLAIM IS FILED UNDER THE PROVISIONS OF 27 CFR (enter applicable regulation section, such as 19.263, 40.283, or 53.173 (see www.ttb.gov).

2.

REMISSION OF TAX

ALLOWANCE OF CREDIT FOR TAX

ABATEMENT OF TAX

ALLOWANCE OF LOSS

ALLOWANCE OF TAX

REFUND OF TAX

DRAWBACK-MNBP

DRAWBACK-EXPORT

OTHER (Specify)

3. NAME AND ADDRESS OF CLAIMANT (Telephone number and e-mail address optional)

4. EMPLOYER IDENTIFICATION NUMBER
5. PLANT, LICENSE, OR PERMIT NUMBER
6. KIND OF TAX
7. PERIOD, IF SPECIAL TAX OR MNBP ONLY (mm/dd/yy)
FROM
8. AMOUNT OF TAX

TO

9. DATE(S) OF PAYMENT (for refunds ONLY)

10. DIRECT DEPOSIT, Optional
10b. TYPE

CHECKING

10a. ROUTING NUMBER
SAVINGS

10c. ACCOUNT NUMBER
11. BASIS OF CLAIM (Give the detailed information required by the applicable regulations under which the claim is filed and any other facts which will
tell the reviewing official of the exact basis for the claim. Please identify any documents or statements submitted in support of this claim.)

(Attach letter size sheets if more space is required)
Under the penalties of perjury, I declare that I have submitted this claim, including supporting documents and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
13. DATE

12. SIGNATURE (Type or print name and title under or beside signature)
TTB F 5620.8 (01/2021)

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INSTRUCTIONS
ITEM 1. Enter the section of the regulations under which you are
filing this claim. You may refer to regulations listed on
the TTB website at www.ttb.gov.
ITEM 2. Select the type of claim you are filing as follows (Note:
The following are general definitions. Please review
regulations for further information on filing claims for
your commodity):
REMISSIONN OF TAX - A qualified permittee, manufacturer, or proprietor may file a claim for remission of tax on
the quantity of distilled spirits, (including distilling material
and denatured spirits) or tobacco products that were lost or
destroyed while in bond, if the tax has not been paid or
determined. A claim of this type may also be filed to cover
underpaid beer lost in transit between breweries and
underpaid wine removed for export, but lost while in transit
to the point of export.
Note:

This type of claim may be filed only by the person
who is liable for paying the tax.

ALLOWANCE OF LOSS - A qualified permittee, manufacturer, or proprietor may file a claim for allowance of loss or
relief of tax liability on denatured spirits, wine, or beer that
have been lost or destroyed on the bonded premises. Or
wine lost or destroyed in transit thereto, if the tax has not
been paid or determined.

ITEM 3.

Enter the claimant's name and address. (Telephone number
and e-mail address are optional)

ITEM 4.

Enter the claimant’s employer identification number.

ITEM 5.

Enter the claimant’s plant, license, or registry number.

ITEM 6.

Enter the kind of tax (excise tax, special tax)

ITEM 7

Enter the period of which the tax was due (this only
applies to special tax or nonbeverage claims). Enter in
mm/dd/year format.

ITEM 8.

Enter the total amount of tax being claimed.

ITEM 9.

Enter the date the tax was paid (if paid) by the claimant.

ITEM 10. Direct Deposit is a safe and secure way to have your refund
deposited automatically.
ITEM 10a. The routing number must be nine digits. On the sample
check below, the routing number is 250250025.
ITEM 10b. Check the appropriate box for the type of account. Do not
check more than one box.

Note: Tax paid distilled spirits, wine, beer, or tobacco
products which are lost or rendered
unmerchantable by accident, disaster, fire, casualty,
or act of God should be filed as a claim for
allowance of credit or claim for refund.

DOLLARS

77%022

Routing
number
ITEM 10a

Account
number
ITEM 10c

Do not include the
check number

For
25025002

20202086

1234

ITEM 10c. The account number can be up to 17 characters (both
numbers and letters). Include hyphens but omit spaces
and special symbols. On the sample check above, the
account number is 20202086.
ITEM 11. Provide detailed information that may be required by the
applicable regulations pertaining to the claim along with
any other necessary facts. Also identify any documents or
statements submitted to support the claim.

ALLOWANCE OF TAX - A tobacco manufacturer, export
warehouse proprietor, or permittee may file a claim for relief
from thepayment of tax on tobacco products, if after
determination of tax and removal from the factory, but prior
to the time for payment of the tax, the articles are lost (other
than by theft) or destroyed by fire, casualty, or act of God.

REFUND OF TAX - A claim may be filed by a taxpayer for
a refund of taxes illegally, erroneously, or excessively
collected. The claim must be filed within three years (two
years under certain circumstances) after the date the tax is
due, or paid, whichever is later.

$

ANYPLACE BANK
Anyplace, VA 2000

ALLOWANCE OF CREDIT - A qualified permitted,
manufacturer, or proprietor may file a claim for allowance
of credit of tax. The approved amount may be applied as
credit toward unpaid taxes or future tax liabilities.

ABATEMENT OF TAX - A claim for abatement of tax on
firearms, ammunition, distilled spirits, wines, beer, or
tobacco products may be filed if the tax is assessed or has
been assessed excessively and the taxpayer believes that
the tax, or any portion of the tax, is not due.

15-0000/0000

PAY TO THE
ORDER OF

DRAWBACK – MNBP – A manufacturer of nonbeverage
products may file a claim for drawback on distilled spirits
used in a TTB approved formula for use as a medicine,
medicinal preparation, food product, flavor, flavor extract, or
any other TTB approved nonbeverage product. Formulas
which are stated in the current revisions or editions of the
United States Pharmacopoeia (U.S.P.), the National
Formulary (N.F.), or the Homeopathic Pharmacopoeia of
the United States (H.P.U.S.) are considered approved
formulas.

DRAWBACK- EXPORT - A qualified winery, distilled spirits
plant, brewery, or tobacco manufacturer may file a claim for
drawback of the tax on taxpaid spirits, wine or beer exported
from the United States. This type of claim cannot be used for
tobacco products exported with the benefit of drawback.

1234

JEFFREY MAPLE
SUZANNE MAPLE
123 Pear Lane
Anyplace, VA 20000

ITEM 12. Enter the signature and title of a person authorized to sign
on behalf of the company/claimant. The name of
the person signing the claim should be typed or legibly
printed under or beside the signature.
ITEM 13. Enter the date the claim was signed.

To submit this form to TTB electronically, see the TTB website at:
https://my.ttb.gov/nrc-claims-submission/claim-form.
Or, mail this form to:
National Revenue Center
Alcohol and Tobacco Tax and Trade Bureau
550 Main Street, Suite 8002, Cincinnati, OH 45202.
If your premise is located in Puerto Rico, then mail this form to:
TTB (PRO)
350 Chardon Ave Suite 310
San Juan PR 00918

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OMB No. 1513-0030 (xx/xx/xxxx)

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used, along
with other supporting documents, to file claims for relief for Federal excise taxes on distilled spirits, wine, beer, tobacco
products, and firearms and ammunition that have been lost or destroyed, relief for such taxes erroneously collected,
over-assessed or overpaid, and to obtain drawback of such taxes paid on exported alcohol and tobacco products or on
distilled spirits used in the preparation of qualified nonbeverage products. This information is required to obtain a
benefit. See 26 U.S.C. 5008, 5044, 5055, 5056, 5062, 5064, 5111-5114, 5370, 5373, 5705, 5706, 5708, 6402-6404,
6416, and 6423.
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 Paperwork Reduction Act Officer, Regulations and Ruling
Division, Alcohol and Tobacco Tax and Trade Bureau, 1310 G Street, NW., Box 12, Washington, DC 20005 (please do
not mail completed forms to this address).
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 STATEMENT
We provide the following information pursuant to section 3 of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)).
1. Authority. We solicit the requested information pursuant to 26 U.S.C. chapters 51, 52, and 65. You must provide
the requested information to obtain a benefit.
2. Purpose. We require the requested information to enable us to act upon your claim for the described tax relief.
3. Routine Uses. We use the provided information to take the action described in paragraph 2. We may disclose the
collected information to other Federal, State, foreign, and local law enforcement and regulatory agencies to verify
information on the form where such disclosure is not prohibited by law. Further, we may disclose the collected
information to the Department of Justice if it appears that the furnishing of false information may constitute a violation
of Federal law. Finally, we may disclose the collected information to members of the public when authorized by
statute or regulation.
4. Effect of Not Supplying Information Requested. If you do not supply complete information, we will not be able to
make a determination regarding your claim for the described tax relief or there will be a delay in processing your claim.

TTB 5620.8 (01/2021)

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