TTB F 5120.24 Drawback on Wines Exported

OMB No. 1513-0016 xx/xx/xxxx
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 

Alcohol and Tobacco Tax and Trade Bureau / National Revenue Center
550 Main Street, Suite 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.

3. EXPORTER - NAME AND ADDRESS (Number, Street, City, State, Zip Code
4. Permit/Registry Number

DATE RECEIVED

5. EMPLOYER IDENTIFICATION NUMBER

TTB F 5620.4
FILED WITH CLAIM NO.2

6. PURPOSE
OF
SHIPMENT
(Make
applicable
entries)
7. CONSIGNED
TO OR IN
CARE OF
(Make
applicable
entries)

TRANSFER TO
SHIPMENT FOR
FOREIGN TRADE
EXPORT TO ARMED
ZONE
FORCES OF THE U.S.
EXPORTATION TO (Name of foreign port and country)

(Number)

USE AS SUPPLIES ON

AIRCRAFT3

CLAIM NUMBER

AMOUNT CLAIMED
$
AMOUNT REJECTED
$

(Location)

AMOUNT APPROVED
A VESSEL3

CLAIMS CLERK

3257DIRECTOR OF CUSTOMS AT PORT OF
TRANSPORTATION (Name)
OFFICER

CUSTOMS OFFICER IN (Number)
CHARGE OF FOREIGN
TRADE ZONE
10. DESCRIPTION OF WINE SHIPPED
KIND
OF
WINE

NUMBER
OF
PACKAGES

(a)

(b)

CASES
BOTTLES
NUMBER in case size
(c)

(d)

8. NAME OF DOMESTIC CARRIER

(Location)
(Location)

9. NAME OF EXPORT CARRIER

SERIAL NUMBERS OF
CONTAINERS OR CASES 4

(e)

(f)

ALC.
CONTENT

TOTAL
WINE
GALLONS

(g)

(h)

DRAWBACK
RATE PER WINE
GALLON
(i)

PART II - CLAIM
The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded within 11. AMOUNT CLAIMED
the limits of the United States. The kind, quantity, and description of the wines stated in Part Iiscorrect, and I am
$
justly entitled to drawback of the tax in the amount claimed herein. Internal Revenue tax equal to such amount has been
12. I REQUEST DRAWBACK
paid or determined as provided by law and regulations. No other claim for allowance of drawback has been made under 26
ALLOWED TO BE PAID
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
BY
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.
CREDIT
CHECK
13. DATE
4. EXPORTER
D. SIGNATURE
14b. TITLE

1. Insert, 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.
2. Complete only for consolidated claims; shown serial number of last claim tabulated.
3. State 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

TTB F 5120.24 (03/2023)

possessions, or between Hawaii or Alaska and any other part of the United
States; (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.

Page 1 of 2

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--

15. LADEN FOR

VESSEL (Name)

AIRCRAFT (Name, symbols, number)

TRUCK (State license)
RAILROAD CAR (Number)
USE AS
SUPPLIES
ON BOARD
17. SHIPPED TO (Frontier Port)
18. SERIAL NUMBER OF SEALS USED
16. RECEIVED IN NUMBER
FOREIGN
TRADE ZONE
DISCREPANCIES
19.
INSPECTION DISCLOSED NO
NO
OR SHORT SHIPMENT
EVIDENCE OF TAMPERING
DISCREPANCY
AS FOLLOWS:
22. SIGNATURE AND TITLE OF CUSTOMS OFFICER
20. DATE
21. PORT
EXPORT

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

NO EVIDENCE OF TAMPERING
SEALS INTACT
SEALS BROKEN

25. INSPECTION DISCLOSED :

24. DATE RECEIVED

26. NATURE AND EXTENT OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
27.

The exporting conveyance noted in Item 15, bearing the wines described in Item 10,
with exceptions as noted in items 0 and 27, cleared from this port for the port of
28. DATE
29. SIGNATURE AND TITLE OF CUSTOMS OFFICER

FOREIGN PORT

PART V - CERTIFICATE OF CLEARANCE OR USE

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

ON (Date)

BOUND FOR (Foreign port)

31. THE WINE HAS BEEN USED AS SUPPLIES ON THE

32. DATE
33. SIGNATURE OF PORT DIRECTOR OF
CUSTOMS
FISHING VESSEL OR AIRCRAFT IDENTIFIED ABOVE,
AND THE EVIDENCE OF SUCH USE HAS BEEN
RECEIVED .
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.
34. DATE
35. DISCREPANCIES
36. SIGNATURE

37. RANK

38. TITLE

INSTRUCTIONS
(1) GENERAL. Under 27 CFR 28.212 and 28.214, persons qualified as proprietors of
distilled spirits plants, bonded wine cellars, or taxpaid bottling houses, or holding
wholesale liquor dealer permits issued under the Federal Alcohol Administration Act, are
authorized to file claims on form TTB F 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 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 (TTB F 5000.24). On shipment of the wine, forward one copy to the Director,
NRC, Alcohol and Tobacco Tax and Trade Bureau, at the address shown in Item 2, and
retain one copy in your files. If a "Consignee's Copy" has been prepared (see Instruction
No. 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 "Certificate 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.
(6) 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 the 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 Paperwork Reduction
Act Officer, Regulations and Rulings 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.

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TTB F 5120.24 (03/2023)