OMB No. 1513-0033 (02/28/2013)
DEPARTMENT OF THE TREASURY
FOR TTB USE ONLY
Audited By
Date Of Audit
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REPORT - MANUFACTURER OF TOBACCO PRODUCTS OR CIGARETTE PAPERS AND TUBES
3. Report Covers Period of: (Read instruction G.)
1. My Employer Identification
2. TTB Permit Number
4.
This report is my first report.
Number (Read instruction E.)
(Read instruction F.)
5.
This report is my last report and I have attached my
permit OR my permit is not attached because:
6. ( Name and Address ) (as listed on my TTB permit)
Large Cigars (Number)
Small Cigars (Number)
Large Cigarettes (Number)
Small Cigarettes (Number)
Chewing Tobacco (Pounds)
(a)
(b)
(c)
(d)
(e)
7. On Hand, in Bond, Start of Period
8. Manufactured
a. From other factories
9.
NO ENTRY
NO ENTRY
b. From customs custody
NO ENTRY
NO ENTRY
NO ENTRY
(1) Puerto Rico
(2) Other than Puerto Rico
c. From export warehouses
d. From foreign trade zones
10. Received by Return to Bond
11. Overages Disclosed by Inventory
12. Other (Specify)
13. TOTAL
14. Removed Subject to Tax
15.
a. For export
b. To export warehouses
c. To other factories
d. To foreign trade zones
e. For use of United States
(Read instruction H)
f. For experimental purposes off factory
premises
a. Consumption by employees off factory
16.
premises
b. Consumption by employees on factory
premises
c. Use for experimental purposes on
factory premises
d. Loss
e. Destruction
f. Reduction to tobacco
17. Shortages Disclosed by Inventory (Read
instruction I.)
18. Other (Specify)
19. On Hand, in Bond, End of Period
20. TOTAL
TTB F 5210.5 (03/2010)