TTB F 5130.Pilot-B Pilot Brewer Excise Tax Return and Report of Operations

OMB No. 1513-XXXX
DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

PILOT BREWER EXCISE TAX RETURN AND REPORT OF OPERATIONS (TTB F 5130.Pilot-B)
NOTE: Please make checks or money orders payable to the ALCOHOL AND TOBACCO TAX AND TRADE BUREAU. Show employer

TAXPAYER IDENTIFICATION
1. Serial Number

TR3a. Reporting Year

2a. Amount Paid

identification number (EIN), Registry Number, and tax period on all checks or money orders. See paper check conversion notice below.*

2b. Form of Payment

2c. Other

3c. Excise Tax Period (Beginning - Ending Date)

3d. Submission Version

$
3b. Period Covers

4. Brewer's Notice Number

3e. Final Tax Return-Discontinuation Date

5. Employer Identification Number (EIN)

BR 6a. Brewery Contact Name (Authority on file with TTB)

7a. Brewery Name

6b. Brewery Contact Phone Number

7b. Brewery Premises Address (Number, Street & Secondary Address)

6c. Brewery Contact Email Address

7c. Brewery Premises Address Continued (City, County, State & Zip Code)

EXCISE TAX CALCULATION

No. of Barrels

Tax Due

Applicable Rate

Tax Due

(a)

(Report taxable removals only for the return period specified in 3c)
8. Beer produced and removed @ $ 3.50 per Barrel

I (or another brewery in my controlled group)
produced this beer and I am eligible for this rate.

9. Beer produced and removed @ $16.00 per Barrel

I (or another brewery in my controlled group)
produced this beer and I am eligible for this rate.

(b)

10. Beer Removed @ $18.00 per Barrel
11. Taxable Beer Removed and Excise Tax Liability for this Period (lines 8 + 9 + 10)
12. Total Increasing Adjustments (equals line 23 of SCHEDULE A)
13. Gross Amount Due (lines 11 + 12)
14. Total Decreasing Adjustments (equals line 27 of SCHEDULE A)
15. Amount Due With This Return (line 13 minus line 14)

SCHEDULE A

INCREASING AND DECREASING ADJUSTMENTS TO EXCISE TAX LIABILITY
Increasing Adjustments

Supporting Information

(Tax Return Serial # When Shortage First
Type of Increasing Adjustment

identified, Export Serial # or Alternate

Unit

Method #)

(a)

16.

barrels

17.

barrels

18.
19.

Quantity

(c)

(b)

(d)

(e)

(f)

barrels
Enter the total calculated tax from your continuation sheet of increasing adjustments.

See Attached

20. Total Increasing Tax Due
21. Interest
22. Penalties
23. Total Increasing Adjustments (lines 20 + 21 + 22)
Decreasing Adjustments
Supporting Information

Balance Left on

Serial # where paid, Alternate Method # or

(Not Taken for

Adjustment This

(d)

(e)

Claim

(e.g., Claim #, Export Serial # w/Return

Type of Decreasing Adjustment
(a)

Event Date)

Approved Claim Amount
(c)

(b)

Adjustment)

24.
25.
26.

See Attached

Enter the total calculated tax from your continuation sheet of decreasing adjustments.

27. Total Decreasing Adjustments

TTB F 5130.pilot-B (10/2023)

Page 1 of 4

Amount of
Period

BREWERY OPERATIONS

No. of Barrels
(a)

(Semi-monthly filers: report operational data for the entire month selected ->>)
28. Total Beer On Hand At the Beginning of Period (line 44 of last report/return)

I. ADDITIONS TO BEER INVENTORY
29. Total Beer Produced This Period
30. Beer Received in Bond - Includes Bulk And Bottled
31. Beer Returned to Brewery After Removal
32. Physical Inventory Disclosed an Overage
33. Total Beer On Hand At the Beginning of Period Plus Additions To Inventory
(add lines 28 + 29 + 30 + 31 + 32)

II. SUBTRACTIONS FROM BEER INVENTORY
A. Beer Removed without Payment of Tax

No. of Barrels
(a)

(Subpart L - Removals Without Payment of Tax)
34. Exports Without Payment of Tax
35. Transfers In Bond
36. Other Removals Without Payment of Tax
37. Total Removals Without Payment of Tax (lines 34 + 35 + 36)

No. of Barrels

B. Other Inventory Subtractions

(a)

38. Beer Consumed or Destroyed on Brewery (Not Tavern) Premises
39. Losses, Including Breakage and Theft
40. Physical Inventory Disclosed A Shortage

III.

I have taxpaid all unexplained shortages on Schedule A above.
No. of Barrels

INVENTORY RECONCILIATION

(a)

41. Total Beer on Hand at the Beginning of Period Plus Additions to Inventory (same as line 33 above)
42a. Beer Barrels Removed Taxpaid on TTB F-5130.Pilot-A, line 11 (Semi-monthly taxpayers only)
42b. Total Beer Barrels Removed Taxpaid this Operational Period (lines 11(a) + 42(a))
43. Total Other Subtractions From Inventory (lines 37 + 38 + 39 + 40)
44. Total Beer on Hand at the End of Period (line 41 minus line 42b and 43)

IV. CONTROLLED GROUP MEMBERSHIP AND CONTRACT ARRANGEMENTS
45. Are you part of a Controlled Group that includes domestic and/or foreign breweries?
If YES, you must answer the following questions. If NO, Skip and go to line 46.
a. Does the controlled group include Domestic breweries?
b. Does the controlled group include Foreign breweries?
46. During this tax period, did you remove and pay tax on beer produced under contract or agreement for other entities?

Signature Under Penalties of Perjury

Under penalties of perjury, I declare that I have examined this Pilot Brewer Excise Tax Return and Report of Operations (including schedule A)
and to the best of my knowledge and belief, it is true, correct, and complete including all transactions and tax liabilities
required by law or regulations to be reported.
49. Signature

47. Printed Name

50. Date

48. Title

* Notice to Taxpayers Making Payment by Check:
If you send us a check, it will be converted into an electronic funds transfer (EFT). This means we will copy your check and use the account information on it to
electronically debit your account for the amount of the check. The debit from your account will usually occur within 24 hours, and will be shown on your
regular account statement. You will not receive your original check back. We will destroy your original check, but will keep the copy of it. If the EFT cannot be
processed for technical reasons, you authorize us to process the copy in place of your original check. If the EFT cannot be processed because of insufficient
funds, we may try to make the transfer up to 2 times.

TTB F 5130.pilot-B (10/2023)

Page 2 of 4

1
2

Brewery Name

Period Covers

EIN

Brewery Notice Number

BR BR -

SCHEDULE A - CONTINUATION SHEET

INCREASING ADJUSTMENTS TO EXCISE TAX LIABILITY

Type of Increasing Adjustment
(a)

Supporting Information
(Tax Return Serial # When Shortage First
identified, Export Serial # or Alternate Method #)
(b)

Unit
(c)

A.

barrels

B.

barrels

C.

barrels

D.

barrels

E.

barrels

F.

barrels

G.

barrels

H.

barrels

I.

barrels

J.

barrels

K.

barrels

L.

barrels

M.

barrels

N.

barrels

O.

barrels

P.

barrels

Q.

barrels

R.

barrels

S.

barrels

T.

barrels

U.

barrels

V.

barrels

W.

barrels

X.

barrels

Y.

barrels

Z.

barrels

AA.

barrels

AB.

barrels

AC.

barrels

AD.

barrels

AE.

barrels

AF.

barrels

AG.

barrels

AH.

barrels

AI.

barrels

AJ.

barrels

AK.

barrels

AL.

barrels

AM.

barrels

AN.

barrels

AO.

barrels

AP.

barrels

Total Increasing Tax Due

Quantity
(d)

Applicable
Rate
(e)

Tax Due
(f)

1
2

Brewery Name

Period Covers

EIN

Brewery Notice Number

BR BR -

SCHEDULE A - CONTINUATION SHEET

DECREASING ADJUSTMENTS TO EXCISE TAX LIABILITY
Claims for Credit

Type of Decreasing Adjustment
(a)

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
W.
X.
Y.
Z.
AA.
AB.
AC.
AD.
AE.
AF.
AG.
AH.
AI.
AJ.
AK.
AL.
AM.
AN.
AO.

Total Decreasing Tax Adjustments

Supporting Information
(e.g., Claim #, Export Serial # w/Return Serial #
where paid, Alternate Method # or Event Date)
(b)

Approved Claim
Amount
(c )

Balance Left on
Claim
(Not Taken for
Adjustment)
(d)

Amount of Adjustment This Period
(e )