)                   

                    05/31/2016

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               $
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (d) 
                                                                                                                                                                                                                               PAGE_____OF____                                                           MONTH 

                    OMB No. 1513-0098  (
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Eligible Spirits Content of Intermediate                                                                                                         Products                                                                                                                                                                                                                                                                                $

                                                                                                                                                                                                                                                                                                         QUARTER 
                                                                                                                                                                                                                                                                            PERIOD COVERED (Check one)            ENDING:___________________________ 
                                                                                                                                                                                                                                                                            2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                           (ineligible                                         (c) 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     In the Manufacture                                                                                             of Nonbeverage                                                   Products          spirits) 

                                                                                                                                                                                                                                                                                                                                                                                                                               SPIRITS RECOVERED                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               $
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         (b) 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        In the Manufacture of Intermediate                                                                         Products (eligible spirits)                                                                                                                                                                                                 $

                                                                                                                                                                                                                                               PART I - IDENTIFICATION DATA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    $
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (a) 
                                        DEPARTMENT OF THE TREASURY 

                                                                   ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB) 
                                                                                                                                                                  (PLEASE READ INSTRUCTIONS BELOW BEFORE COMPLETING THIS FORM)                                                                                                                                                                                                                                                                                                                 New Spirits (eligible, not previously                                                                            used in intermediate or nonbeverage                                            products)                                                                                                                                                                                       $

                                                                                                                                                                                                                                                                                                                                                     PART II - DISTILLED SPIRITS ACCOUNT (IN PROOF GALLONS,  EXCEPT LINES 1-2) 
                                                                                                                  SUPPORTING DATA FOR NONBEVERAGE DRAWBACK CLAIMS 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              No

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    ) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Yes                                                                                                                                                                                                                    RECEIVED                        RECOVERED PRODUCED                                            USED IN NONBEVERAGE PRODUCTS                              USED IN INTERMEDIATE PRODUCTS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     5.                              6.        7.                                                  10.                                                       11.                                               12.  OTHERWISE USED (not subject to drawback)                                                                                                                        11/2014
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    (

                                                                                                                                                                                                                                                                            NAME AND ADDRESS OF CLAIMANT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         KIND (optional, except for Puerto Rican or U.S. Virgin Islands spirits, and imported rum) EFFECTIVE TAX RATE PER PROOF GALLON  ON HAND, START OF PERIOD IN PROCESS, START OF PERIOD                                                    GAINS TOTAL TO ACCOUNT FOR (add lines 3-8)                                                                                                                                                           LOSSES ON HAND, END OF PERIOD                          IN PROCESS, END OF PERIOD
                                                                                                                                                                                                                                                                            1.                                                                                                                                                                   Was a physical inventory taken per 27 CFR 17.167(a)?                                                                                                                                      (Check one)                                                                                                                                                           1.                                                                                        2.                                   3.                       4.                                   DURING         PERIOD:                    8.    9.                                                                DURING                                                    PERIOD:                                                                                                                                            TOTAL ACCOUNTED FOR (add lines 10-15)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             13.    14.                                             15.                      16.                                           TTB F 5154.2

on this form are correct, to the best of my knowledge. I certify, under the penalties of perjury, that the data submitted 14. 13. 12. 11. 10. 9. 8. 7. 6. 5. 4. 3. 2. 1.

INFORMATION FROM TTB FORM 5154. 1

PRODUCT NAME OF
(a)

         FORMULA  NO.  
“NF ,”  “USP” or PART III - PRODUCTION OF NONBEVERAGE PRODUCTS
“HPUS”)
(b)
 SIGNATURE AND TITLE
PART IV - ADDITIONAL AND EXPLANATORY INFORMATION (or

 (proof gals.) SPIRITS USED RECOVERED INELIGIBLE
(c)

 rum, other kinds) spirits, imported KIND 

(d) (P .R. or V.I.

$ $ $ $ $ $ $ $ $ $ $ $ $ $
effective tax rate)  (= $1.00 less than DRAWBACK RATE ELIGIBLE SPIRITS USED

(e)

AMOUNT USED
(proof  gals.)
(f)

(wine gals., except AMOUNT PRODUCED
dry products) FINSHED PRODUCT PRODUCED
(g)
DATE
PAGE 
TTB F 5154.2

CONTENT BY           OF
VOLUME ALCOHOL
(h)
 (
11/2014
% % % % % % % % % % % % % %
)

TTB F 5154.2 

INFORMATION FROM TTB FORM 5154. 1
( (Please number each line)
11/2014 NAME  OF PRODUCT

)
(a)

PART III - PRODUCTION OF NONBEVERAGE PRODUCTS (Continued)

FORMULA  NO.  
“NF ,”  “USP” or
“HPUS”)
(b)

(or

SPIRITS USED RECOVERED INELIGIBLE
(proof gals.) 
(c)

 rum, other kinds) spirits, imported KIND 

(d) (P .R. or V.I.

ELIGIBLE SPIRITS USED
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
effective tax rate)  (= $1.00 less than DRAWBACK RATE

(e)

AMOUNT USED
(proof  gals.)
(f)

(wine gals., except AMOUNT PRODUCED
dry products)
FINISHED PRODUCT PRODUCED
(g)

PAGE 

CONTENT BY           OF
VOLUME ALCOHOL
(h)

% % % % % % % % % % % % % % % % % % % %

 ,
 
 .  -
125(b), .
 in such a ,
17.162(d)) 
 addition § 
such

( and (e) are not required; column (f) )d, 173(c)(2)(viii) or § 26.309(c)(2)(viii).  .

(c), 

 column (g) should be used to show the amount of product brought ; payment as required by § 26 

. (1) In column (b), if a formula was adopted from another plant under § 17 nd words such as “addition after assay” must be added in column (a). . (1) Part IV must contain an explanation of any discrepancies (gains or losses) 
a 167(a). .
IV.  usage must be shown in batch records, however, per § 17.164(b).  (e), and (f). (This requirement does not pertain to claimants under 27 CFR Part 26) rum.
 
 PART III te plant from which the formula was adopted must be indicated in addition to the formula h
number. This may be done by a letter or other symbol if the meaning is explained in Part should be used to state the proof gallons contained in each product (which may be less than the amount used) into the U.S. products (i.e. spirits from the account in column (c) of Part II). Note that usage of other  ineligible spirits (i.e. spirits derived from nonbeverage products) is not reported in Part Ill.  Such during the claim period in any nonbeverage product, then the number of proof gallons for each kind and for each drawback rate must be shown separately by subdividing columns (d), In column (d), imported rum must be distinguished from other rum; spirits from Puerto Rico or the U.S. Virgin Islands must be distinguished if (and only if) they contain at least 92% yield must be shown in the same units used to express yield in the approved formula,  TTB F 5154.1. product that was recorded as completed during a previous claim period, must be recorded on a separate line in Part Ill. The amount shown in column (f) case, must be only the additional volume of finished product created by addition of the spirits, PART IV in the distilled spirits account (Part II) recorded by the physical inventory required  in § 17 the U.S. Virgin Islands containing at least 92% rum, were used subject to drawback in nonbeverage products, Part IV must state the total number of proof gallons so used during the period for each of those three categories. Such amounts must include eligible spirits or rum from intermediate products and eligible recovered spirits. Ineligible spirits must not be included. back claimed, due to a gain in a shipment of spirits received (as required by or to a gain in spirits on hand (as required by § 17.167(a)), this must be noted in Part IV. manufacturer of each product (if different from the claimant), the date of entry into the U S. and the evidence of tax
(C) (2) For claimants under 27 CFR Part 26: Columns (3)  In column (c), show usage only of spirits recovered in the manufacture of nonbeverage (4)  If spirits of more than one kind, or taxpaid at more than one effective tax rate, were used (5) (6)  Yield of finished product (column (g)) must be shown in wine gallons. For dry products, (7)  If distilled spirits were added, as described in § 17.152(c), to a batch of nonbeverage        (D) (2)  For claimants under 27 CFR Part 17 only: If imported rum, or spirits from Puerto Rico or (3)  For claimants under 27 CFR Part 17: If a deduction was taken from the amount of draw  (4)  For claimants under 27 CFR Part 26 only: Part IV must state the name and address of the 

. 
005
ll I  
 not DC 20
17.152.  
must

PAPERWORK REDUCTION ACT NOTICE  
INSTRUCTIONS FOR TTB F 5154.2

 be in proof gallons. This form may bet

 be accompanied by supporting data  1310 G Street, NW., Box 12, Washington 
must

17.162(d)) are not reported in Part II; nevertheless, such gains must ) 
.
147. All quantities of spirits mus. § 14
/20
(11
products  
. (1) Each claim for drawback . The continuation sheet may be photocopied.  rum, (B) spirits from the U.S. Virgin Islands containing at least 92% rum, and  
(1) Persons filing claims under 27 CFR Part 26 for Puerto Rican or Virgin Islands %
imported rum. These separate accounts must be maintained in columns (a), (b), and (d). 
provided
GENERAL containing the information presented by this form. Regulations pertaining to this form are found in 27 CFR 17 photocopied. information pertinent to the manufacturing operation is shown. If certain lines or columns do not apply to an operation, then such lines or columns may be omitted. In omitting lines or columns, the letter or numerical designations of the remaining lines and columns be changed. A continuation sheet for persons claiming on more than 14 products in Part is into the U.S. from Puerto Rico or the U.S. Virgin Islands under the provisions of 27 CFR Part 26, as well as by domestic manufacturers claiming drawback under 27 CFR Part 17. Certain instructions that only pertain to one of these types of claimants are so indicated. Such instructions are not to be confused with instructions pertaining to use, by domestic manufacturers, of Puerto Rican or Virgin Islands spirits. PART II. products are not required to complete Part II. Separate accounts must be kept under Part II for spirits taxpaid at different effective tax rates. Separate accounts must also be kept for: (A) spirits from Puerto Rico containing at least 92 (C) Only a single account is needed in column (c), since spirits reported there are ineligible for drawback. If desired, additional separate accounts may be kept for other “kinds” (e.g.  alcohol of various proofs in column (a), different products in column (d), etc.). If more than two accounts are needed in any column, the form may be modified or Part II may be  photocopied. nonbeverage products prior to the time of “use” of the spirits as determined under § Spirits in process are distinguished by their source; thus, for example, spirits “in process” in an unfinished intermediate product would appear in column (a) if the spirits had not been previously used, but they would appear in column (d) if they had come from other  intermediate physical inventory was required for that claim period. Any gain reported in columns (a), (b), or (d) of line 8 must be reflected by an equivalent deduction from the amount of drawback claimed. Gains must not be offset by losses. Note: Gains and losses determined on initial receipt of spirits (see be reported in Part IV and deducted from the claim. the full volume of such products.  This request is in accordance with the Paperwork Reduction Act of 1995. This form is used by TTB to verify that products on which drawback is claimed were made according to  approved nonbeverage formulas, and that regulatory requirements have been met. The information is required to obtain a benefit.  The estimated average burden associated with this collection of information is 58 minutes per respondent or recordkeepeer, 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, 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 F 5154.2 
Please mail this form to TTB 550 Main St Suite 8002, Cincinnati, OH 45202 unless your premise is in Puerto Rico, then mail to TTB (PRO), 350 Chardon Ave Suite 310, San Juan PR  00918 A) (2)  Modifications of this form may be used without prior authorization, as long as all required (3)  This form may be used by persons claiming drawback on nonbeverage products brought (4)  Supplies of this form may be obtained from formsrequest@ttb.gov or 1-877-882-3277. (B) (2) (3)  In lines 4 and 15, spirits “in process” are spirits contained in unfinished intermediate or (4)  Gains (line 8) and losses (line 13) must be reported when determined, even if no (5)  Note that column (d) only calls for the eligible spirits content of intermediate products, not Please mail