Atf Form 1582-A - Drawback On Wines Exported printable pdf download

(g)

Form Approved: OMB No. 1512-0082 (5/31/00)

DEPARTMENT OF THE TREASURY—BUREAU OF ALCOHOL, TOBACCO AND FIREARMS

1. SERIAL NUMBER (Begin with

"1" each Jan. 1)

D R A W B A C K O N W I N E S E X P O R T E D

(See instructions on back)

REGIONAL REGULATORY

PART I – NOTICE

ADMINISTRATOR

LOCATED AT (Number, Street, City, State, ZIP Code)

2. TO: REGIONAL REGULATORY

USE ONLY

ADMINISTRATOR–BUREAU OF

CLAIM NUMBER

ALCOHOL, TOBACCO AND FIREARMS

The undersigned gives notice of the shipment of wines manufactured bottled or packaged in the United States on

which drawback of the internal revenue tax paid or determined is claimed.

DATE RECEIVED

(Number, Street, City, State, ZIP Code)

EXPORTER

NAME AND ADDRESS

WITH CLAIM NO.

AMOUNT CLAIMED

EMPLOYER IDENTIFICATION NUMBER

SHIPMENT FOR EX -

TRANSFER TO

PORT TO ARMED

FOREIGN

AMOUNT REJECTED

4. PURPOSE

FORCES OF THE U.S.

TRADE ZONE

EXPORTATION To (Name of foreign port and country)

SHIPMENT

AMOUNT APPROVED

CLAIMS CLERK

DISTRICT DIRECTOR OF CUSTOMS AT PORT OF

6. NAME OF DOMESTIC

5. CON-

CARRIER

SIGNED TO

OR IN

TRANSPOR-

(Name)

(Location)

CARE OF

TATION

—

7. NAME OF EXPORT CARRIER

(Make

OFFICER

applicable

CUSTOMS OFFICER IN

(Number)

(Location)

entries)

CHARGE OF FOREIGN-

TRADE ZONE

8. DESCRIPTION OF WINE SHIPPED

CASES

TOTAL

DRAWBACK

KIND

NUMBER

ALCOL.

SERIAL NUMBERS OF

RATE PER

CON-

WINE

BOTTLES

NUMBER

WINE

PACKAGES

GALLONS

WINE GALLON

TENT

In Case

Size

(h)

(i)

(a)

(b)

(c)

(d)

(e)

(f)

PART II – CLAIM

9. AMOUNT CLAIMED

The wines described in Part I have been removed for the purpose stated, and are not to be brought back or relanded

within the limits of the United States. The kind, quantity, and description of the wines as stated in Part I are correct,

and I am justly entitled to drawback of tax in the amount claimed herein. Internal revenue tax equal to such amount

10. I REQUEST DRAWBACK

ALLOWED TO BE PAID

has been paid or determined as provided by law and regulations. No other claim for allowance of drawback has been

made under 26 U.S.C. 5062(b), or Section 309 of the Tariff Act of 1930, as amended, on these wines or any part

thereof. Under penalties of perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my

knowledge and belief the statements herein and in Part I are true, correct, and complete.

11. DATE

12. EXPORTER

12a. BY (Signature and Title)

1 Insert, as applicable, plant number of distilled spirits plant, registry

and any other part of the United States; (c) vessel of the United States

number of bonded wine cellar or taxpaid wine bottling house, or

engaged in trade between Atlantic and Pacific ports of the United

number of the wholesale liquor dealer’s permit issued under the Federal

States; (d) vessel of war of any foreign nation; or (e) vessel employed in

Alcohol Administration Act.

(1) the fisheries, or (2) the whaling business. Show name of vessel,

country of registry, and ports of call, or if a whaling vessel, location of

2 Complete only for consolidated claims; show serial number of last

operations. If aircraft, show also name of airline and country of reg-

claim tabulated.

istry of aircraft.

3 State whether (a) vessel or aircraft operated by the United States; (b)

4Show filling date when use of such date has been authorized in lieu of

vessel or aircraft engaged in foreign trade, or in trade between the

serial numbers on cases.

United States and any of its possessions, or between Hawaii or Alaska

ATF FORM 1582-A (5120.24) (7-83)

Atf Form 1582-A - Drawback On Wines Exported

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