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FOR ACTIVITY PRIOR TO 2018 Reset Print Blank Form Print Completed Form OMB No. 1513-0053
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REPORT OF WINE PREMISES OPERATIONS
PERIOD COVERED (Year Only, or Year & Month, or Year & Quarter) OPERATED BY (Name, Address,and Telephone)
YEAR ____________ MONTH _______________
QUARTERLY: January to March July to September
_______________ _______________April to June _______________October_______________to December ______________________________ _______________ _______________ ______________________________ _______________ _______________ _______________ _______________
VERSION (Select Original or Amended. Select_______________ Final if this is the last report for the business) EIN REGISTRY NUMBER
Original Amended Final Report
_______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _________
INSTRUCTIONS
1. The reporting period for this form must be monthly, except that proprietors who qualify under 3. Explain any unusual operations in Part X.
the exception stated in 27 CFR 24.300(g)(2) may file this form on a quarterly or calendar year
basis unless required to file monthly by the Alcohol and Tobacco Tax and Trade Bureau (TTB). 4. The quantities "on hand end" will ordinarily be "book inventory" figures, that is the quantity
A proprietor who files monthly reports but does not expect any reportable operations in a required to balance each summary. Use the "on hand end" from your report for the previous period
subsequent month or months may indicate in Part X that no monthly reports will be filed until a as the "on hand beginning" of the current report. On reports for any period when you take a
reportable operation occurs (ยง 24.300(g)(1)). physical inventory, report the difference as losses for bulk wine and shortages for bottled wine, or as
gains, as the case may be.
2. Prepare this form in duplicate and file it by the fifteenth day after the end of the report period
( month, quarter, or year) . Keep the copy on your bonded wine premises for inspection by TTB 5. If the quantity of wine previously reported on TTB F 5120.17 is affected by adjustments made on
officers. Send the original to TTB at this address: Director, National Revenue Center, Alcohol and a tax return, TTB F 5000.24, adjust the current TTB F 5120.17 in Section A (and Section B, if
Tobacco Tax and Trade Bureau, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215. bottled wine is involved). Explain the entries in Part X.
_______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _________
PART I - SUMMARY OF WINES IN BOND (GALLONS)
ALCOHOL CONTENT BY VOLUME ARTIFICIALLY
ITEM NOT OVER 14 OVER 14 TO 21 PERCENT OVER 21 TO 24 PERCENT CARBONATED SPARKLING WINE HARD CIDER1/
PERCENT (Inclusive) (Inclusive) WINE (e) (f)
(a) (b) (c) (d)
SECTION A - BULK WINES
1. ON HAND BEGINNING OF PERIOD
2. PRODUCED BY FERMENTATION2/ BF
BP
3. PRODUCED BY SWEETENING
4. PRODUCED BY ADDITION OF WINE SPIRITS
5. PRODUCED BY BLENDING
6. PRODUCED BY AMELIORATION
7. RECEIVED IN BOND
8. BOTTLED WINE DUMPED TO BULK
9. INVENTORY GAINS
10.
11.
12. TOTAL 0.00 0.00 0.00 0.00 0.00 0.00
13. BOTTLED3/ BF
BP
14. REMOVED TAXPAID
15. TRANSFERS IN BOND
16. REMOVED FOR DISTILLING MATERIAL
17. REMOVED TO VINEGAR PLANT
18. USED FOR SWEETENING
19. USED FOR ADDITION OF WINE SPIRITS
20. USED FOR BLENDING5/
21. USED FOR AMELIORATION
22. USED FOR EFFERVESCENT WINE
23. USED FOR TESTING
24.
25.
26.
27.
28.
29. LOSSES (OTHER THAN INVENTORY)
30. INVENTORY LOSSES
31. ON HAND END OF PERIOD
32. TOTAL 0.00 0.00 0.00 0.00 0.00 0.00
SECTION B - BOTTLED WINES
1. ON HAND BEGINNING OF PERIOD
2. BOTTLED3/ BF
BP
3. RECEIVED IN BOND
4. TAXPAID WINE RETURNED TO BOND
5.
6.
7. TOTAL 0.00 0.00 0.00 0.00 0.00 0.00
8. REMOVED TAXPAID
9. TRANSFERRED IN BOND
10. DUMPED TO BULK
11. USED FOR TASTING
12. REMOVED FOR EXPORT
13. REMOVED FOR FAMILY USE
14. USED FOR TESTING
15.
16.
17.
18. BREAKAGE
19. INVENTORY SHORTAGE4/
20. ON HAND END OF PERIOD
21. TOTAL 0.00 0.00 0.00 0.00 0.00 0.00
TTB F 5120.17sm_pre2018 (12/2016)
1/ Hard cider: (a) Contains no more than 0.64 gram of carbon dioxide per 100 milliliters of wine; (b) Is derived primarily from apples or pears, or from apple juice concentrate or pear juice concentrate and water, as described in 27
CFR 24.332(a); (c) Contains no fruit product or fruit flavoring other than apple or pear, as described in 27 CFR 24.332(b) and (c); and (d) Contains at least one-half of 1 percent and less than 8.5 percent alcohol by volume.
2/ Enter in col. (e) on line marked "BF" the quantity of sparkling wine produced by fermentation in bottles, and on line marked "BP" the quantity of sparkling wine produced by bulkprocess.
3/Section A line 13 and Section B line 2 should sho wthe same quantities. Enter in col. (e) on line marked "BF" the quantity of finished bottle fermented sparkling wine bottled, and on line marked "BP" the quantity of finished bulk process wine
bottled.
4/Fully explain in either Part X, or on a separate signed statement submitted with this report. Failure to satisfactorily explain shortages of bottled wine ma yresult in the assessment of tax seapplicable to those shortages.
5/Only report blending if wines of different tax classes are bendedl together. Page 1 of 2
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