OMB NO. 1513-0112 (12/31/2008)
SECTION 3 – OWNERSHIP INFORMATION
INDIVIDUAL OWNER PARTNERSHIP CORPORATION LLC OTHER (Specify)
FULL NAME
RESIDENCE ADDRESS
POSITION
FULL NAME
RESIDENCE ADDRESS
POSITION
FULL NAME
RESIDENCE ADDRESS
POSITION
FULL NAME
RESIDENCE ADDRESS
POSITION
FULL NAME
RESIDENCE ADDRESS
POSITION
INSTRUCTIONS
GENERAL INSTRUCTIONS
This registration is for use on and after July 1, 2008. If you are
engaged in one or more of the alcohol activities listed on this form, you
are required to file this form before beginning business. If there is a
change in your business, you need to report it on or before the next
July 1 (see CHANGES IN OPERATIONS, below). You may file one
registration to cover several locations or several types of activity
operating under the same Employer Identification Number (EIN).
NOTE: The special (occupational) tax on producers and marketers of
alcohol beverages was repealed by Section 11125 of Public Law 109-
59, effective July 1, 2008. However, tax liability and the registration
requirement for periods before that date remain. If you need to file a
delinquent or amended registration for a period through June 30, 2008,
please use TTB Form 5630.5a, Alcohol Special (Occupational) Tax
Registration and Return – For Periods Ending On or Before June 30,
2008.
SIGNING YOUR REGISTRATION
This form must be signed by the individual owner, a partner, or, in the
case of a corporation or LLC, an individual authorized to sign on behalf
of the corporation or LLC.
SECTION 1 – IDENTIFYING INFORMATION
Complete Section 1, Identifying Information, as specified on the form.
Your registration must contain a valid Employer Identification Number
(EIN). The EIN is a unique number for business entities issued by the
Internal Revenue Service (IRS). You must have an EIN whether you
are an individual owner, partnership, corporation, LLC, or a
government agency. If you do not have an EIN, contact the Internal
Revenue Service immediately to obtain one. While TTB may assign a
temporary identification number (beginning with XX) to allow initial
processing of a return which lacks an EIN, do not delay submission of
your registration pending receipt of your EIN. If you have not received
a number by the time you file this return, write "number applied for" in
the space for the number. Submit your EIN by separate
correspondence after receipt from the IRS.
SECTION 2 – PREMISES LOCATIONS
Enter the requested information in Section 2 for each premises location
even if this repeats the business information listed in Section 1. If you
are reporting a change, enter the date of the change in the appropriate
space in Section 1. If additional sheets are needed, make a copy of
page 1 of this form or enter the requested information on a separate
sheet of paper with your EIN and Company’s name.
SECTION 3 – OWNERSHIP INFORMATION
Please complete the ownership information in Section 3. Supply the
information specified for each individual owner, partner or responsible
person. For a corporation, partnership or association, a responsible
person is anyone with the power to control the management policies or
buying or selling practices pertaining to alcohol. For a corporation,
association, or similar organization, it also means any person owning
10 percent or more of the outstanding stock in the business.
CHANGES IN OPERATIONS
If there is a change of your company’s name, trade name, address,
premises location, telephone number, ownership information, type of
business, or EIN, complete TTB F 5630.5d and submit it no later than
the next July 1 after the change. Check the box, Existing Business
with Change(s), complete all fields in Section 1, and complete Sections
2 and 3 as necessary to show any changes there. Upon going out of
business, submit TTB F 5630.5d within 30 days, checking box b in
Section 1. If you are still in business but there are no changes since
your last registration, this form does not need to be submitted.
MAILING INSTRUCTIONS
Please sign and date this registration and mail it to:
Alcohol and Tobacco Tax and Trade Bureau
550 Main Street, Suite 8002
Cincinnati, OH 45202-5215.
CONTACT INFORMATION
For further assistance, contact TTB National Revenue Center at 1-800-
937-8864 or 1-877-882-3277; or email to ttbtaxs tamp
@ttb.gov.
Additional information is also available at our Web site, www.ttb.gov.
PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information is used to ensure compliance with Section 11125 of Public
Law 109-59, and the Internal Revenue Laws of the United States.
The estimated average burden associated with this collection of information is .8 hour per respondent or record keeper, depending on individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the
Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C. 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB
control number.
Page 2 of 2 TTB F 5630.5d (05/2009)
