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                                                                                                                                            OMB No. 1513-0083
                                             DEPARTMENT OF THE TREASURY                                           1. SERIAL NUMBER
           ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB) 
                                             EXCISE TAX RETURN                                                    3. AMOUNT OF PAYMENT
                                             (Prepare in duplicate – See instructions below) 
2. FORM OF PAYMENT                                                                                                  $
     CHECK     MONEY ORDER                                                 EFT   OTHER  (Specify)                          PLEASE MAKE CHECKS OR MONEY ORDERS 
                                                                                                                    NOTE: 
4. RETURN COVERS (Check one)                                                                                        PAYABLE TO THE ALCOHOL AND TOBACCO TAX AND 
                                                                               BEGINNING                            TRADE BUREAU (SHOWEMPLOYER  IDENTIFICATION 
                                                                                                                    NUMBER ON ALL CHECKS OR MONEY ORDERS).  IF 
     PREPAYMENT                                                 PERIOD                                              YOU SEND A CHECK, SEE PAPER CHECK CONVERSION 
                                                                                                 ENDING            NOTICE BELOW.
5. DATE PRODUCTS TO BE REMOVED (For Prepayment Returns Only)                                                                    FOR TTB USE ONLY 
6. EMPLOYER IDENTIFICATION NUMBER                                          7. PLANT, REGISTRY, OR PERMIT NUMBER           TAX  $ 
                                                                                                                    PENALTY 
8. NAME AND ADDRESS OF TAXPAYER  (Include ZIP Code)                                                                 INTEREST 
                                                                                                                        TOTAL  $ 
                                                                                                                  EXAMINED BY: 
                                                                                                                  DATE EXAMINED: 
              CALCULATION OF TAX DUE  (Before making entries on lines 18 – 21, complete Schedules A and B) 
                                             PRODUCT                                                                        AMOUNT OF TAX 
                                                                       (a)                                                       (b) 
9. DISTILLED SPIRITS                                                                                      $
10. WINE
11. BEER
12. CIGARS
13. CIGARETTES
14. CIGARETTE PAPERS AND/OR CIGARETTE TUBES
15. CHEWING TOBACCO AND/OR SNUFF
16. PIPE TOBACCO AND/OR ROLL-YOUR-OWN TOBACCO
17. TOTAL TAX LIABILITY  (Total of lines 9-16)                                                            $                                                          0.00
18. ADJUSTMENTS INCREASING AMOUNT DUE  (From line 29)                                                                                                                0.00
19. GROSS AMOUNT DUE  (Line 17 plus line 18)                                                              $                                                          0.00
20. ADJUSTMENTS DECREASING AMOUNT DUE                                          (From line 34)                                                                        0.00
21. AMOUNT TO BE PAID WITH THIS RETURN  (Line 19 minus line 20)                                           $                                                          0.00
Under penalties of perjury, I declare that I have examined this return  (including any accompanying explanations, statements, schedules, and forms)  and 
to the best of my knowledge and belief it is true, correct, and includes all transactions and tax liabilities required by law or regulations to be reported. 
22. DATE   23. SIGNATURE                                                                                            24. TITLE

                                                                       SCHEDULE A – ADJUSTMENTS INCREASING AMOUNT DUE 
    EXPLANATION OF INDIVIDUAL ERRORS OR TRANSACTIONS                                                              AMOUNT OF ADJUSTMENTS 
                                             (a)                                                          (b) TAX       (c) INTEREST        (d) PENALTY
25.                                                                                                     $                                 $ 
26. 
27. 
28. SUBTOTALS OF COLUMNS (b), (c), and (d)                                                              $     0.00  $            0.00 $                              0.00
29. TOTAL ADJUSTMENTS INCREASING AMOUNT DUE  (Line 28, Col (b) + (c) + (d))  Enter here and on line 18.                                 $                            0.00
                                                                       SCHEDULE B – ADJUSTMENTS DECREASING AMOUNT DUE 
          EXPLANATION OF INDIVIDUAL ERRORS OR TRANSACTIONS                                                                AMOUNT OF ADJUSTMENTS 
                                                                           (a)                                          (b) TAX             (c) INTEREST
30.                                                                                                               $                $ 
31. 
32. 
33. SUBTOTALS OF COLUMNS (b) and (c)                                                                              $              0.00  $                             0.00
34. TOTAL ADJUSTMENTS DECREASING AMOUNT DUE  (Line 33, Col (b) + (c))  Enter here and on line 20.                                      $                             0.00
Notice to Customers 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 we 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 completed because of insufficient funds, we may try to make the transfer up to 2 times.
TTB F 5000.24sm (11/2016) 



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35. ADDITIONAL REMARKS  (Reference by item number and use a separate sheet if necessary)

                                                                                                                                                                                                                                               INSTRUCTIONS 
1.  Prepare TTB F 5000.24sm, Excise Tax Return, in duplicate. The return must                                                                                                                                                                                                9. SCHEDULE A. Use Schedule A to report adjustments increasing the amount 
   cover all tax liabilities incurred or discovered during the tax period.                                                                                                                                                                                                      due (for example, an error in a previous return period that resulted in an 
2.  Prepare a separate TTB F 5000.24sm for each distilled spirits plant, bonded wine                                                                                                                                                                                            underpayment of tax). In addition, proprietors of distilled spirits plants must use 
   cellar or winery, brewery, tobacco products factory, or cigarette papers and                                                                                                                                                                                                 Schedule A to report the tax and interest, if any, on unexplained shortages of 
   tubes factory from which you make removals subject to tax.                                                                                                                                                                                                                   bottled distilled spirits, as required by 26 U.S.C. 5008(a) (1) (C), and proprietors 
                                                                                                                                                                                                                                                                                of small winery premises who overestimated their wine credits must compute the 
3.  TTB Form 5000.24sm must be used as both a prepayment tax return and a deferred                                                                                                                                                                                              tax and interest as required by 27 CFR 24.279(a). 
   payment tax return. Except as noted below, you must file TTB F 5000.24sm for 
   each tax return period, whether or not you prepaid all tax liabilities incurred                                                                                                                                                                                         10. SCHEDULE B. Use Schedule B to report adjustments decreasing the amount 
   during the period. Exceptions: (a) distilled spirits plant proprietors who are not                                                                                                                                                                                           due (for example, an error in a previous return period that resulted in an 
   exempt from bond requirements under 27 CFR 19.151(d) and who do not have                                                                                                                                                                                                     overpayment of tax). Prepayments of tax, claims approved for credit of tax, the 
   an approved bond covering the deferred payment of taxes; (b) proprietors of                                                                                                                                                                                                  number of gallons and the applicable tax credit allowed for being a small winery,
   bonded wine cellars or wineries who have no tax due, per 27 CFR 24.271; (c)                                                                                                                                                                                                  and other authorized adjustments must be reported in Schedule B. You may 
   manufacturers of tobacco products who have complied with the provisions of 27                                                                                                                                                                                                carry over to Schedule B of your next tax return the unused portion of any 
   CFR 40.162; and (d) manufacturers of cigarette papers and tubes who have                                                                                                                                                                                                     approved tax credits or adjustments. 
   complied with the provisions of 27 CFR Part 40.                                                                                                                                                                                                                         11. EXPLANATION OF ADJUSTMENTS. You must fully explain adjustments reported 
4.  Export warehouse proprietors transmitting remittances for unassessed liabilities                                                                                                                                                                                            in Schedules A and B. Identify any prepayments by serial number of the tax return 
                                                                                                                                                                                                                                                                                other cases, you must enter, as a minimum, the date of the transaction 
   Calculationitems(27 CFR2, 3,44.67)6-8,of TaxandmustDue22-24.prepareandTheymakeTTBmustanyF 5000.24. alsonecessarycompleteTheexplanationproprietorsappropriateinmustitemlinecomplete35.items under                                                                             ofonanwhicherror,thethetaxdatewasaprepaid.shortageIdentifywas found,approvedetc.),claimsthe identityby claimandnumber.quantity(theInofdateallthe 
                                                                                                                                                                                                                                                                                product involved in the adjustment, and the reason for the adjustment. If neces-
5. ITEM 1. Begin with "1" January 1 of each year. Use a separate series of numbers                                                                                                                                                                                              sary, use the space above or attach a separate sheet to explain adjustments fully. 
                                                                                                                                                                                                                                                                           12. 
   with the prefix "P" to designate prepayment returns. Begin with "P-1" to designate the first prepayment return filed on or after January 1 of each year.                                                                                                                     INTEREST. The law provides for the payment of interest on underpayments and 
                                                                                                                                                                                                                                                                                overpayments of tax. Interest, if applicable, will be computed at the rate prescribed 
6.  If this form contains pre-printed information in items 6, 7, or 8, and the information                                                                                                                                                                                      by 26 U.S.C. 6621 and reported as a separate entry in Schedule A or B. To avoid 
   is incorrect, make the necessary corrections by crossing out any errors and print-                                                                                                                                                                                           paying interest on unexplained shortages of bottled distilled spirits, you must re-
   ing the correct information in the same area.  If there is no pre-printed                                                                                                                                                                                                    port the shortage on the tax return covering the period in which you discovered the 
   information in these areas, print or type the required information in the spaces                                                                                                                                                                                             shortage. Interest is not allowed on adjustments involving the prepayment of tax or 
   provided.                                                                                                                                                                                                                                                                    approved claims for credit of tax (unless the approved claim specifically authorized 
7. ITEM 6. Enter your employer identification number here and on all checks or                                                                                                                                                                                                  such interest).
   money orders which accompany your return. If you have not been assigned an                                                                                                                                                                                                   Compute the interest on underpayments from the due date of the return in error to 
   employer identification number, you must obtain and file Form SS-4 with your                                                                                                                                                                                                 the date of payment. Compute the interest on overpayments from the date of 
   local Internal Revenue Service office.                                                                                                                                                                                                                                       overpayment to the due date of the return on which the credit is taken. 
8. LINES 9-21. Show on the appropriate line or lines the amount of tax being pre-                                                                                                                                                                                          13. Enter "NONE" in Schedule A or Schedule B if there is no transaction. 
   paid or, if the return covers a tax return period, the tax liability incurred during the 
   period. If the return covers a tax return period, you must include at lines 9-16 all                                                                                                                                                                                    14. Payment must accompany this form except when the payment is by electronic 
   tax liabilities incurred during the period even if you have already prepaid the tax.                                                                                                                                                                                         funds transfer (EFT). 
   (You will show prepayments in Schedule B as adjustments decreasing the                                                                                                                                                                                                  15. Mail this return to:
   amount due.) 

   totalBrewersequalremovalsnumberthemustduringtotalofcalculatenumberbarrelsthe returnofreturnedthebarrelsperiod.amounttoremovedFortheof taxanybreweryreportedforreturnconsumptionfromperiod,atwhichLinenet11removedortaxableusingsale minusnetduringremovalstaxablethethe            TTBSt.P.ExciseO.Louis,BoxTaxMO 79035363179-0353 
   same period. 
                                                                                                                                                                                                             PAPERWORK REDUCTION ACT NOTICE 
This request is in accordance with the Paperwork Reduction Act of 1995. The                                                                                                                                                                                                purpose of this information is to identify taxpayers, the period covere  andd,
the amount of tax due for each tax return. The information is used by the Government                                                                                                                                                                                                to ensure that the correct tax payment was m                                               ade and received. The 
information is mandatory by statute (26 U.S.C. 5061, 5703). 
The estimateda  verage b denassociated ur                                                                                         ththiswi               collecton s i5 h i .7                                                                 our perrespondent or                            recordkeeper depending onindividu                                  alci umstances.rc
Comments concerning the accuracyof                                                                                                this bur               den estimate and suggestions forreducing                                                                                      this b rdenu                  should be directed to the                     Reports Management 
Officer, Regulations and Rulings Division, Alcohol andTobacco                                                                                                                                                            Tax and Trade Bureau,                                        1310 G Street, NW, Box 12, Washington, D.C. 20005. 
An agency may not conduct orsponsor,                                                                                              and a p rsone                              is not required to respondto, a                                                                    collecton ofi         information uness itldisplay  a cusent, validrr                                  OMB 
control number. 
                                                                                                                                                                                                                                                
A Privacy Act Statement required by 5 U.S.C. 552a(e)(3) stating our authority for soliciting and collecting the information from your check, and explaining 
the purposes and routine uses which will be made of your check information, is available at http://www.ttb.gov/pdf/notice-of-system-records.pdf, or call toll        
free at (877)882-3277 to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so may  require you to make payment
by some other method. 
                                                                                                                                                                                                                   
We provide this information to comply with Section 3 of the Privacy Act of 1974 (5 U.S.C., 552(a)(e)(3)).
We require this information under the authority of 26 U.S.C. 6302. You must disclose this information so we may identify you as a taxpayer, the period  
covered, and the amount of tax due for each return. This information also ensures the correct tax payment was made and received.  
We use this information to make determinations for the purposes described in paragraph 2. Also, we may disclose the information to other Federal, State,  
foreign, and local law enforcement and regulatory agency personnel to verify information on the form where law does not prohibit such disclosure. We may
disclose the information to the Justice Department if it appears that the furnishing of false information may constitute a violation of Federal law. Finally, we
may disclose the information to members of the public in order to verify information on the form where law does not prohibit such disclosure.
If you fail to supply complete information, there will be a delay in the processing of your return.
                                                                                                                                                                                                                                                                                                                                                    TTB F 5000.24sm(11/2016)                                                      






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