Form Atf F 1582-B - Drawback On Beer Exported printable pdf download

Form Atf F 1582-B - Drawback On Beer Exported

Approved: OMB No. 1512-0083 (8/31/98)

F o r m

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

Serial Number (The exporter will

DRAWBACK ON BEER EXPORTED

number each from beginning with

"1" each January 1.)

(Prepare in quadruplicate, see instructions on back of this form)

FOR USE OF THE REGIONAL

Part l-Notice

REGULATORY ADMINISTRATOR

Notice is hereby given of the shipment of taxpaid beer on which drawback of internal revenue tax paid thereon will be

ONLY

claimed by the producing brewer.

Claim Number

2. Name and address of exporter (Number and Street, City, State, ZIP Code)

Date Received

3. Name and address of producing brewer

4. Address of the Regional Regulatory Administrator,

Bureau of Alcohol, Tobacco and Firearms for the

Amount Claimed

Region in which Producing Brewer is Located

Transfer to

Shipment for export

, (Number)

(Location)

Amount Rejected

Foreign-

to Armed Forces of

Trade Zone

the U.S.

Exportation to (Name of foreign port and country)

Amount Approved

Use as supplies on

Claims Clerk

Director of customs at port of

7. Name of Domestic Carrier

(Location)

(Name)

Transportation

Officer

8. Name of Export Carrier

(Location)

Customs Officer in Charge (Number)

of Foreign-Trade Zone

Number

K i n d

Kind

Size

Number

Kind

Number

Size

(d)

(h)

(a)

(b)

(c)

(e)

(f)

(i)

(g)

11. Exporter

10. Date

11a. By (Signature and title)

Part II - Claim

To: Regional Administrator, Bureau of Alcohol, Tobacco and Firearms

The beer described in Part I has been removed for the purpose stated and is not to be brought back or remanded within the limits of the United States. The

quantity of beer, as described in Part I and restated below in terms of barrels, is correct, and such beer was brewed or produced in the United States. I am

justly entitled to drawback of tax in the amount claimed herein. Internal revenue tax equal to such amount has been determined and paid as provided by law

and regulations. No other claim for allowance of drawback has been made on this beer or any part thereof.

13. Quantity of beer (Barrels)

14b. Drawback Claimed

12. Date

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.

15a. By (Signature and title)

rate of tax.

ATF F 1582-B (5130.6) (7-83)