Form Atf F 5630.5 Special Tax Registration And Return Alcohol And Tobacco
ADVERTISEMENT
1
2OMB NO. 1512-0472 (09/30/2002)
DEPARTMENT OF THE TREASURY
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
SPECIAL TAX REGISTRATION AND RETURN
ALCOHOL AND TOBACCO
(Please Read Instructions on Back Carefully Before Completing This Form)
SECTION I - TAXPAYER IDENTIFYING INFORMATION
1. EMPLOYER IDENTIFICATION NUMBER
(Required see
2. BUSINESS TELEPHONE NUMBER
FOR ATF USE ONLY
instructions)
(
)
3. NAME (Last, First, Middle)
or
CORPORATION NAME (If Corporation)
T
FF
4. TRADE NAME
FP
5. MAILING ADDRESS (Street address or P.O. box number)
I
6. CITY
STATE
ZIP CODE
T
ACTUAL LOCATION (IF DIFFERENT THAN ABOVE)
9. TAX PERIOD COVERING
7. PHYSICAL ADDRESS OF PRINCIPAL PLACE OF BUSINESS (Show street address)
FROM:
(mm/dd/yy)
8. CITY
STATE
ZIP CODE
TO: June 30,
(yy)
SECTION II - TAX COMPUTATION
TAX CLASS DESCRIPTION (FOR ITEMS MARKED*, SEE INSTRUCTIONS)
MONTHLY
ANNUAL
LOCATIONS
TAX DUE
CODE
(a)
(b)
(c)
(d)
(e)
(f)
RETAIL
Liquors (Distilled spirits, wine or beer)
$20.83 1/3
$250
11
DEALER
Beer only
$20.83 1/3
250
12
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
BREWER
Regular rate
$83.33 1/3
1000
41
REDUCED rate*
$41.66 2/3
500
43*
NONBEVERAGE DRAWBACK CLAIMANT
500
51
INDUSTRIAL
$20.83 1/3
250
55
User of specially denatured alcohol
ALCOHOL
$20.83 1/3
250
56
Dealer in specially denatured alcohol
$20.83 1/3
250
57
User of tax-free alcohol
ALCOHOL
$83.33 1/3
1000
58
Proprietor of alcohol fuel plant
PRODUCERS
$41.66 2/3
500
59*
Proprietor of alcohol fuel plant - REDUCED*
$83.33 1/3
1000
81
Proprietor of distilled spirits plant
$41.66 2/3
500
86*
Proprietor of distilled spirits plant - REDUCED*
$83.33 1/3
1000
82
Proprietor of bonded wine cellar
$41.66 2/3
500
87*
Proprietor of bonded wine cellar - REDUCED*
$83.33 1/3
1000
83
Proprietor of bonded wine warehouse
$41.66 2/3
500
88*
Proprietor of bonded wine warehouse - REDUCED*
$83.33 1/3
1000
84
Proprietor of tax paid wine bottling house
$41.66 2/3
500
89*
Proprietor of tax paid wine bottling house - REDUCED*
$83.33 1/3
1000
91
Manufacturer of tobacco products
TOBACCO
$41.66 2/3
500
95*
Manufacturer of tobacco products - REDUCED*
PRODUCTS
$83.33 1/3
1000
92
Manufacturer of cigarette papers and tubes
$41.66 2/3
500
96*
Manufacturer of cigarette papers and tubes - REDUCED*
$83.33 1/3
1000
93
Proprietor of export warehouse
$41.66 2/3
500
97*
Proprietor of export warehouse - REDUCED*
MAKE CHECK OR MONEY ORDER PAYABLE TO "BUREAU OF ALCOHOL, TOBACCO AND
TOTAL TAX DUE $
0.00
FIREARMS", WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK AND SEND IT
WITH THE RETURN TO BUREAU OF ATF, P.O. BOX 371962, PITTSBURG, PA 15250-7962.
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, 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
ATF F 5630.5 (10-99) PREVIOUS EDITIONS ARE OBSOLETE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal