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                                                                                                             OMB NO. 1513-0112 (03/31/20              12) 
             DEPARTMENT OF THE TREASURY                                              FOR TTB USE ONLY  
 ALCOHOL AND TOBACCO TAX AND TRADE BUREAU 
                                                                         T      FF                        FP         I            T 
 ALCOHOL SPECIAL (OCCUPATIONAL) TAX 
                                                                                                                                      
       REGISTRATION AND RETURN –  
 For Periods Ending On or Before June 30, 2008 
                           SECTION I – TAXPAYER IDENTIFYING INFORMATION (REGISTRATION) 
                                        (Please read instructions carefully  before completing this form) 
Employer Identification Number(Required)           Business Telephone Number        Tax Periodmm/dd/yyyy (One period per form)
                                                   (           )                                                 to   06  30           
Name (Last, First, Middle) or Corporate Name (If Corporation)              Doing Business As 
                                                                                 
Mailing Address (Street Address or P.O. Box)                               City                                  State    Zip Code 
                                                                                                                             
ACTUAL LOCATION (If Different Than Above) 
Physical Place of Business Address (Street Address)                        City                                  State    Zip Code 
                                                                                                                             
         SECTION II(a) TAX COMPUTATION (Pay this tax for periods          prior to July 1, 2008, only.  See Instructions) 
       TAX-CLASS DESCRIPTION (REDUCED* See instructions.)                  MONTHLY      ANNUAL            LOCATIONS    TAX DUE                        CODE
                                    (a)                                         (b)       (c)                (d)          (e)                         (f) 
              User of specially denatured alcohol                          $20.83 1/3     $250                                                        55 
INDUSTRIAL 
ALCOHOL       Dealer in specially denatured alcohol                        $20.83 1/3     $250                                                        56 
              User of tax-free alcohol                                     $20.83 1/3     $250                                                        57 
         SECTION II(b) – TAX COMPUTATION (Pay this tax for periods prior to July 1, 2005, only.  See Instructions) 
              Liquors (Distilled spirits, wine or beer)                    $20.83 1/3     $250                                                        11 
RETAIL        Beer only                                                    $20.83 1/3     $250                                                        12 
DEALER        Liquors (Distilled spirits, wine or beer) - at large         $20.83 1/3     $250                                                        15 
              Beer only - at large                                         $20.83 1/3     $250                                                        16 
WHOLESALE     Distilled spirits, wine or beer                              $41.66 2/3     $500                                                        31 
DEALER        Beer only                                                    $41.66 2/3     $500                                                        32 
              Regular rate                                                 $83.33 1/3   $1,000                                                        41 
BREWER 
              REDUCED rate*                                                $41.66 2/3     $500                                                        43* 
NONBEVERAGE DRAWBACK CLAIMANT                                                             $500                                                        51 
              Proprietor of alcohol fuel plant                             $83.33 1/3   $1,000                                                        58 
              Proprietor of alcohol fuel plant - REDUCED*                  $41.66 2/3     $500                                                        59* 
              Proprietor of distilled spirits plant                        $83.33 1/3   $1,000                                                        81 
              Proprietor of distilled spirits plant - REDUCED*             $41.66 2/3     $500                                                        86* 
ALCOHOL       Proprietor of bonded wine cellar                             $83.33 1/3   $1,000                                                        82 
PRODUCERS     Proprietor of bonded wine cellar - REDUCED*                  $41.66 2/3     $500                                                        87* 
              Proprietor of bonded wine warehouse                          $83.33 1/3   $1,000                                                        83 
              Proprietor of bonded wine warehouse - REDUCED*               $41.66 2/3     $500                                                        88* 
              Proprietor of taxpaid wine bottling house                    $83.33 1/3   $1,000                                                        84 
              Proprietor of taxpaid wine bottling house - REDUCED*         $41.66 2/3     $500                                                        89* 
Make check or money order payable to "ALCOHOL AND TOBACCO TAX AND TRADE BUREAU", write your employer                 TOTAL TAX DUE 
identification number on the check and send it with the return to TTB SOT TAX, 550 MAIN ST, STE 8002, CINCINNATI, OH 
45202-5215.  See Notice regarding check payments in Instructions.                                                    $      0.00
Under penalties of perjury, I declare that the statements in this return/registration are true and correct to the best of my knowledge and belief; that this 
return/registration applies only to the specified business and location or, where the return/registration is for more than one location, it applies only to the 
businesses at the locations specified on the attached list. Note: Violation of Title 26, United States Code 7206, with respect to a declaration under 
penalties of perjury, is punishable upon conviction by a fine of not more than $100,000 ($500,000 in the case of a corporation) or imprisonment for not 
more than 3 years, or both, with the costs of prosecution added thereto. 
SIGNATURE                                          TITLE                                                       DATE 
                                                                                                                     
 TTB F 5630.5a (11/2009)



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                                                                                        OMB NO. 1513-0112 (03/31/2012) 
                                      SECTION III – BUSINESS REGISTRATION 
OWNERSHIP INFORMATION: (Check One Box Only) 
  INDIVIDUAL OWNER          PARTNERSHIP          CORPORATION                LLC         OTHER (Specify)        
OWNERSHIP RESPONSIBILITY: (Read instruction sheet; use a separate sheet of paper if additional space is needed.) 
FULL NAME                         ADDRESS                                       POSITION 
                                                                                      
FULL NAME                         ADDRESS                                       POSITION 
                                                                                      
FULL NAME                         ADDRESS                                       POSITION 
                                                                                      
FULL NAME                         ADDRESS                                       POSITION 
                                                                                      
FULL NAME                         ADDRESS                                       POSITION 
                                                                                      
  GROSS RECEIPTS less than $500,000   (See instructions for reduced rate taxpayers on the instruction sheet) 
  NEW BUSINESS      (NOTE: Retailers and wholesalers show date alcoholic  DATE BUSINESS BEGAN  (mm/dd/yyyy) 
  beverage sales began.  Producers, manufactures and users show date            
  business commenced)                                                      
  EXISTING BUSINESS WITH CHANGE IN:  (CHECK APPROPRATE BOX BELOW) 
   (a) NAME/TRADE NAME                                                    DATE OF CHANGE (mm/dd/yyyy) 
                                                                                
   (b)     ADDRESS                                                        DATE OF CHANGE (mm/dd/yyyy) 
                                                                                
   (c)     OWNERSHIP                                                      DATE OF CHANGE (mm/dd/yyyy) 
                                                                                
   (d)  EMPLOYER IDENTIFICATION NUMBER                                    DATE OF CHANGE (mm/dd/yyyy) 
           (OLD:        -             ) (NEW:          -                 )      

   (e)  BUSINESS TELEPHONE NUMBER                                          
   (      )         
                                                                          DATE BUSINESS DISCONTINUED (mm/dd/yyyy) 
  DISCONTINUED BUSINESS                                                         

                                      PAPERWORK REDUCTION ACT NOTICE 
This request is in accordance with the Paperwork Reduction Act of 1995. This information is used to ensure compliance 
by taxpayers of P.L. 100-647, Technical Corrections Act of 1988, and the Internal Revenue Laws of the United States. 
The information collections are used to determine and collect the right amount of tax. 
The estimated average burden associated with this collection of information is .8 hour per respondent or record keeper, 
depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for 
reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and 
Tobacco Tax and Trade Bureau, Washington, D.C. 20220. 
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. 
(See attached instruction sheet) 

                                                                                                TTB F 5630.5a(11/2009)



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                                                                                                         OMB NO. 1513-0112 (12/31/2008) 
                                                       INSTRUCTION SHEET 
ALCOHOL SPECIAL (OCCUPATIONAL) TAX REGISTRATION AND RETURN – For Periods Ending On or Before June 30, 2008 
               GENERAL INSTRUCTIONS                                            SECTION I - TAXPAYER IDENTIFYING INFORMATION 
This Special Tax Registration and Return applies only to tax periods           Complete Section I,  Taxpayer Identifying Information, as specified on 
prior to July 1, 2008.  For periods after July 1, 2008, use TTB F 5630.5d,     the form.  Enter the tax period covered by the return in the space 
Alcohol Dealer Registration.  If you were engaged in one or more of the        provided.   Your return must contain a valid Employer Identification 
alcohol activities listed on this form, you are required to file this form and Number (EIN). The EIN is a unique number for business entities issued 
pay any special (occupational) tax (SOT) that is due before beginning          by thr Internal  Revenue Service (IRS).   You must have an EIN 
business.  You may file one return to cover several locations or several       whether you are an individual owner, partnership, corporation, LLC, or 
types of activity.  However, you must submit a separate  return for each       a government agency.  If you do not have an EIN, contact the Internal 
tax period.  The SOT periods began on July 1 and end on June 30.  The          Revenue Service immediately to obtain one.  While TTB may assign a 
due date for each period was July 1 (except in the case of nonbeverage         temporary identification number (beginning with XX) to allow initial 
drawback claimants who were required to pay special tax before filing          processing of a return which lacks an EIN, do not delay submission of 
claims).  If you did not pay on a timely basis, interest and penalties are     your return and payment pending receipt of your EIN. If you have not 
incurred.                                                                      received a number by the time you file this return,  write "number 
                                                                               applied for" in the space for the number.  Submit your EIN by separate 
The special tax rates listed on this form became effective January 1,          correspondence after receipt from the IRS. 
1988. If you were engaged in an alcohol related activity prior to this 
date and did not pay SOT, please contact the TTB National Revenue              SECTION II - TAX COMPUTATION 
Center for assistance.  If you engaged in a taxable activity at more           To complete Section II(a) or II(b), enter th e number of locations in 
than one location, attach to your return a sheet showing your name,            Column (d ) on the appropriate line(s) and multiply  by  the tax rate, 
trade name, address and employer identification number and the                 Column (c).  Insert the tax due in Column (e).  If you began operations 
complete street addresses of all additional locations.                         (except for nonbeverage drawback operations) after the month of July , 
                                                                               then you were responsible for paying a prorated amount for the 
On October 22, 2004, H.R. 4520, the American Job Creation Act of               portions of the year you were in business.   To compute your taxes, 
2004 was signed into law. As part of this act, the payment of SOT was          multiply the monthly rate, Column (b), by the number of locations, 
suspended for certain businesses (listed under Section II(b)), for a 3-        Column (d), and then by the number of months, treating parts of 
year period from July 1, 2005 until June 30, 2008 . These businesses           months as whole months, from the date you commenced operations 
were still required to file this registration during the suspension period.    through June 30.  (For example, if you commenced operations on  
On August 10, 2005, the President signed into law the "Safe,                   March 14,  you would multiply by 4.) Compute the  taxes due for each 
Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for       class and enter the total amount due in the block "Total Tax Due". 
Users,” Public Law 109-59. Section 11125 of that act repealed the              SECTION III - BUSINESS REGISTRATION 
special (occupational) taxes on producers and  marketers of  alcohol  
beverages, manufactures of non beverage products, users of tax-free            Please complete the ownership information in Section III.  Supply the 
alcohol, and users and dealers of specially denatured spirits, effective       information specified for each individual owner, partner or responsible 
July 1, 2008.  However, tax liability and the registration requirement for     person.  For a corporation, partnership or association, a responsible 
periods before that date remain.                                               person is anyone with the power to control the management policies or 
                                                                               buying or selling practices pertaining to alcohol.  For a corporation, 
DEFINITIONS                                                                    association or similar organization, it also means any person that 
A RETAIL DEALER (tax class codes 11, 12, 15, or 16) is anyone who              owned 10 percent or more of the outstanding stock in the business. 
sells or offers for sale, beverage alcohol products to any person other        MAILING INSTRUCTIONS 
than a dealer.  Examples of retailers are package stores, restaurants, 
bars, private clubs, fraternal organizations, grocery stores or                Please sign and  date the  return, make  your check or money order 
supermarkets which sell such beverages.                                        payable to Alcohol a nd T obacco Tax and  Trade Bureau, for the 
                                                                               amount in the Total Tax Due block and mail the form along with the 
A RETAIL DEALER AT LARGE is one who moves his activity from                    payment to  
place to place in different States, such as a circus or carnival. 
                                                                               SOT Tax 
A WHOLESALE DEALER (tax class codes 31 or 32) is anyone who                    Alcohol and Tobacco Tax and Trade Bureau 
sells or offers for sale, beverage alcohol products to another dealer. An      550 Main St 
IMPORTER is liable for tax as a wholesaler if he or she sells beverage         Ste 8002 
alcohol products to other dealers (wholesalers or retailers).                  Cincinnati, OH 45202-5215 
INSTRUCTIONS FOR REDUCED RATE TAXPAYERS                                        If you need further assistance contact TTB National Revenue Center at 
The  reduced  rates for certain taxpayer classes, indicated with an            1-800-937-8864 or 1-877-882-3277 or you may send an email to 
asterisk (*) in Section II(b), apply only to those taxpayers whose total       ttbtaxstamp@ttb.gov. Additional information is also available at our 
gross receipts for the income tax year prior to the Special Tax period         Website, WWW.TTB.GOV. 
were less than $500,000 (not just receipts relating to the activity            NOTICE TO CUSTOMERS MAKING PAYMENT BY CHECK: If  you 
subject to special tax).  However, if you were a member of a controlled        send us a check, it will be converted into an electronic funds transfer 
group as defined in section 5061(e) (3) of the Internal Revenue Code,          (EFT). This means we  will copy your check and use the account          
you were not eligible for this reduced rate unless the total gross             information on it  to electronically debit your account for the amount of 
receipts for the entire group were less than $500,000.  If your business       the check. The debit from your  account will usually occur within 24 
began an activity subject to special tax for the first time, you may have      hours, and will be shown on your regular account  statement.  You will 
qualified for a reduced rate in your initial tax year if your gross receipts   not r eceive your original check back. We will destroy your original 
for the  business (or  the entire  controlled group , if a member  of a        check, but we will keep the copy of it. If the EFT cannot be processed 
controlled group) were under $500,000 the previous year. If you were           for technical reasons, you authorize us to process the copy in place of 
eligible for the reduced rate, check the item in Section III and compute       your original check. If the EFT cannot be completed  because of 
your tax using the reduced rate in Section II.                                 insufficient funds, we may try to make the transfer up to 2 times 
SIGNING RETURN                                                                  
This form must be signed by the individual owner, a partner, or, in the 
case of a corporation, an individual authorized to sign for the 
corporation. 
                        
TTB F 5630.5a (11/2009)





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