Form Ttb F 5120.25 - Application To Establish And Operate Wine Premises printable pdf download

OMB No. 1513-0009 (/3/20)

1. SERIAL NUMBER

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

2. DATE

APPLICATION TO ESTABLISH AND OPERATE WINE PREMISES

3. REGISTRY NUMBER

(Leave blank if

(See Instructions on next page)

new applicant)

4. TO: DIRECTOR, NATIONAL REVENUE CENTER

5. APPLICATION IS MADE TO OPERATE (Check one only)

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

BONDED

BONDED WINE

TAX PAID WINE

0DLQ 6W 6WH &LQFLQQDWL 2+

WINERY

CELLAR

BOTTLING HOUSE

6. NAME AND PRINCIPAL BUSINESS ADDRESS OF APPLICANT

7. ADDRESS (Address where wine operations will occur.)

(Name and street, city, county, State, and ZIP Code)

(If different from address in Item 6)

PHONE #

EIN#

8. PURPOSE FOR WHICH FILED (Such as original establishment, trade name change, alteration of premises)

New Premises or change in Proprietorship

Original:

Alternating Proprietorship with:

Amended for:

Change in Location

Change in Control (Date_/_/_)

Alternating Premises with:

Change in information on

Change in Name of Proprietor

application

or Trade Name

Other: Please Specify

Change in Officers

APPLICATION FORM AND ATTACHED STATEMENTS AND DOCUMENTS SHOWING REQUIRED INFORMATION IN ITEMS 1-8 ON REVERSE OF FORM

This application includes: (1) this form; (2) the papers and documents which are being submitted for the first time, and whicK are listed in Items 9A

and 9B; (3) the current papers and documentV from the latest approved TTB F 5120.25 Serial No. _______, which are listed in Items 9A-1 and 9B-1;

and (4) the supporting organizational documents filed in connection with another establishment but incorporated in this application by reference,

and listed below in Item 9C.

9A.NUMBER OF PAGES ATTACHED TO THIS FORM ( )

9A-1. PAGES FROM CURRENT APPROVED TTB F 5120.25 THAT REMAIN

PAGE NUMBERS

9B. ORGANIZATIONAL DOCUMENTS SUBMITTED WITH THIS FORM

9B-1. ORGANIZATIONAL DOCUMENTS FILED WITH PRIOR

(List each document)

APPROVED TTB F 5120.25 (List each document)

9C. ORGANIZATIONAL DOCUMENTS FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT BUT INCORPORATED IN THIS APPLICATION BY

REFERENCE (List each document, and show the name or plant number under which filed)

NO WINE MAY BE PRODUCED OR UNTAXPAID WINE RECEIVED UNTIL THE PREMISES AND OPERATIONS ARE APPROVED BY THE DIRECTOR,

NATIONAL REVENUE CENTER.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS APPLICATION AND, TO THE BEST OF MY KNOWLEDGE AND

BELIEF, IT IS TRUE, CORRECT, AND COMPLETE.

10. SIGNATURE

11. TITLE

FOR TTB USE ONLY

APPLICATION IS

EFFECTIVE DATE

APPROVED

DISAPPROVED

SIGNATURE OF DIRECTOR, NATIONAL REVENUE CENTER

DATE

TTB F 5120.25 (0/20)

Form Ttb F 5120.25 - Application To Establish And Operate Wine Premises

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