OMB No. 1513-0008 (04/30/2015)
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU                                     1. SERIAL NUMBER
APPLICATION AND PERMIT TO SHIP LIQUORS AND ARTICLES OF PUERTO RICAN
               MANUFACTURE TAXPAID TO THE UNITED STATES
                                                   PART I - APPLICATION
2.  To The Secretary of the Treasury of Puerto Rico
3.  Application is made to ship the following liquors or articles of Puerto Rican manufacture to the United States in
(Check one)    bottles and cases               packages
                                               4. DESCRIPTION OF LIQUORS OR ARTICLES
                       KIND OF                         NO. OF SIZE OF NO. OF                       CONTENTS          RATE   AMOUNT OF  
SERIAL NOS.            LIQUOR OR  BRAND NAME           CASES  BOTTLES BOTTLES   WINE               PROOF  PROOF    OF                    TAX
OF PACKAGES            ARTICLE                         OR              PER                                   GALS.     I.R. 
                                                        PKGS           CASE                                           TAX
          (a)              (b)                 (c)     (d)    (e)      (f)                     (g) (h)      (i)      (j)                (k)

5.  FORMULA            6.  FORM NUMBER                        7.  SERIAL NUMBER (If any)                             8.  DATE APPROVED
(If any)
9.   TO BE SHIPPED BY (Name of vessel)                        10.  TO (Port of arrival in U.S.)

11.  NAME OF CONSIGNEE                                        12.  ADDRESS OF CONSIGNEE

Under the penalties of perjury, I declare that the taxes equal to the Internal Revenue taxes imposed on like liquors and articles in the United 
States have been paid or deferred on such liquors or articles, as prescribed by regulations in 27 CFR Part 26, and that this application and the 
statements therein have been examined by me and, to the best of my knowledge and belief, are true, correct, and complete.
13.  DATE              14.  APPLICANT                                  15.  By (Signature and Capacity)

                                       PART II - CERTIFICATE OF INTERNAL REVENUE AGENT
To The Secretary of the Treasury of Puerto Rico
I hereby certify that taxes equal to the Internal Revenue taxes imposed on like liquors or articles in the United States have been paid or deferred 
on the liquors or articles described in Part I, as prescribed by regulations in 27 CFR Part 26.
16.  DATE              17.  REVENUE AGENT

                                                       PART III - PERMIT TO SHIP
Permit is hereby granted to the applicant designated in Item 8 to ship to the United States the liquors or articles described in Part I.
18.  DATE              19.  SECRETARY                                  20.  BY

PART IV — CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION IN PUERTO RICO
I hereby certify that, except as noted in Item 15, the liquors or articles described in Part I were duly inspected and laden for shipment to the 
United States.
21.  NAME OF VESSEL                                           22.  BOUND FOR PORT OF

23.  EXCEPTIONS

                                                                                                                     TTB FORM 5170.7 (09/2013)

24.  DATE                    25.  CUSTOMS AND BORDER PROTECTION OFFICER 26.  AREA PORT DIRECTOR

                PART V - CERTIFICATE OF AREA PORT DIRECTOR OF CUSTOMS AND BORDER PROTECTION AT PORT OF ARRIVAL IN  
                                                          UNITED STATES 
I hereby certify that the liquors or articles described in Part I were received and have been inspected and released as follows: 
27.  DATE                                    28.  PORT OF                   29.  QUANTITY INSPECTED AND RELEASED 

                                            31.  Identify separately the quantity lost from each container and the serial number of each container.  
                                                                                                                                 1
                                            (a)  CONTAINER SERIAL NUMBER                                    (b)  QUANTITY LOST

30.  Lost by breakage or otherwise     
       during transportation to the United  
       States.  

                             1 
32.  TOTAL QUANTITY LOST

33.  CUSTOMS AND BORDER PROTECTION OFFICER                               34.  AREA PORT DIRECTOR  

1
 Identify, as applicable, in terms of "proof gallons" (spirits), "wine gallons" (wine), or "barrels" (beer) 

1. GENERAL. The shipper must prepare this form in sextuplet for each     The shipper must then submit the two copies to the Area Port 
consignment. A separate TTB F 5170.7 is required for each product        Director in Puerto Rico at least six hours prior to the intended lading 
covered by an approved formula. Forms must be serially numbered          of the merchandise. 
beginning with "1" each calendar year, and running consecutively           
thereafter to the end of the year. The serial number must be prefixed    5. PART IV. The Area Port Director in Puerto Rico, on release of the 
by the last two digits of the calendar year, e.g., 07-1."                merchandise for shipment, must execute his/her certificate in Part IV 
                                                                         on all copies, retain one copy for his/her files, mail the original to the 
2. PART I. The shipper must prepare Part I. Where the shipment           Director of Customs at the port of arrival in the United States, 
covers wine, enter the tax class of the wine in column 2(h) and          dispatch a second copy to said Port Director on the vessel 
disregard column 2(i). Where the shipment covers beer, modify the        concerned for the guidance of the inspector who will handle the 
heading of column 2(g) to read "barrels" and enter quantity in barrels;  cargo, and return two copies to the shipper. After the shipment has 
disregard columns 2(h) and 2(i). After executing his/her application in  been cleared, the shipper must retain one copy of the form and send 
Part I, the shipper must deliver all copies of the form to the Internal  one copy, with other shipping documents, to the Area Port Director 
Revenue Agent.                                                           at the port of arrival. 
                                                                           
3. PART II. After executing his/her certificate in Part ll, the Internal 6. PART V. The Area Port Director at the port of arrival in the United 
Revenue Agent must forward all copies of the form to The Secretary of    States, after executing his certificate on all copies of the form 
the Treasury of Puerto Rico.                                             received by him/her, must retain the original for his/her files, and 
                                                                         forward the two remaining copies to the District Director, Puerto Rico 
4. PART III. After executing his/her permit to ship on all copies of the Operations, TTB, Ste 310 Torre Chardon, 350 Carlos Chardon Ave, 
form, the Secretary must retain one copy, send the original and two      San Juan, PR 00918. 
copies to the Area Port Director in Puerto Rico, and return two copies    
to the shipper. 

                                            PAPERWORK REDUCTION ACT NOTICE  
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection documents transactions of taxable 
commodities on which tax has not been paid. TTB uses the information to determine that the transaction is in accordance with laws and 
regulations and establish the person responsible for the tax involved in the transaction. Information requested is mandatory by statute  
(26 USC 5314 and 7652). 
  
The estimated average burden associated with this collection of information is 30 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 Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, 
DC 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.
                                                                                                            TTB FORM 5170.7 (09/2013)