Submit the original
of the completed form in hard copy by mail to USDA, Economic and Policy
Analysis Staff,
Entity must complete Items 1
through 14.
|
Fld Name / |
Instruction |
|
1 Company Name and Address |
Enter company name as listed on your TTB permit. Enter current mailing address. |
|
2 Contact Person Name |
Enter name of person authorized by company to fill out this form. |
|
3 TTB Permit Number |
TTB assigned this “number” on your permit as a manufacturer or importer of tobacco products. For example, if you are a manufacturer, TP-XX-12345 where XX is a 2-letter State abbreviation. If you are an importer, XX-TI-12345 where XX is a 2-letter State abbreviation. |
|
4 Telephone Number |
Enter the telephone number of the contact person. |
|
5 Taxpayer Identification Number |
Enter the nine-digit code that the Internal Revenue Service (IRS) has assigned to your business. |
|
6 |
Enter the email address of the contact person. |
|
7A Month |
Enter the month the report covers. |
|
7B Year |
Enter the year the report covers. |
|
8A-13D |
|
|
Column A |
This column should be filled out by manufacturers only. Enter the volume of product removed subject to tax during the reporting month in the row that indicates the type of tobacco product removed. Report volume in number of sticks for cigarettes and cigars, and in pounds for all other types of tobacco. If no removals were made enter zero. The volume you report should match the volume you reported on form TTB5210.5, line 14. |
|
Column B |
This column should be filled out by manufacturers only. Enter the federal excise taxes paid for the volume you reported in Column A. The taxes you report for the month should match the taxes you reported on TTB5000.24. |
|
Column C |
This column should be filled out by importers only. Enter the volume of product removed subject
to tax during the reporting month in the row that indicates the type of
tobacco product removed. Report volume
in number of sticks for cigarettes and cigars, and in pounds for all other
types of tobacco. If no removals were
made enter zero. The volume you report
should match the volume reported to you on CBP 7501 Importer Entry Summary, |
|
Column D |
This column should be filled out by importers only. Enter the federal excise taxes paid for the
volume you reported in Column C. The
taxes you report for the month should match the taxes reported to you on CBP |
|
14A Signature |
Enter the name of the individual who has signature authority granted by company. |
|
14B Title |
Enter the title of the person certifying the report. |
|
14C Date Prepared |
Enter the date the report was prepared. |