DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
MONTHLY REPORT OF PROCESSING OPERATIONS
1. PLANT NUMBER
2. MONTH AND YEAR
OMB No. 1513-0041 (04/30/2017)
3. NAME OF PROPRIETOR
5. Employer Identification Number (EIN)
1.
Every proprietor engaged in processing operations must prepare this form each month in duplicate.
2.
The proprietor must forward the original to the Director, National Revenue Center, 550 Main St, Ste 8002, Cincinnati, OH
45202-5215, on or before the 15th day of the month following the month for which prepared.
3. The copy is to be kept on file by the proprietor.
PART I - BULK INGREDIENTS PART II - FINISHED PRODUCTS
TRANSACTION
BOTTLED
(Proof gallons)
PACKAGED
(Proof gallons)
TRANSACTION WINE
(Proof gallons)
SPIRITS
(Proof gallons)
(a)
(b) (c) (a) (b) (c)
1. ON HAND FIRST OF MONTH
2. RECEIVED (Other than line 3)
4. ALCOHOL, FLAVOR, MATERIALS DUMPED
5. WINE MIXED WITH SPIRITS
6. DUMPED FOR FURTHER PROCESSING
3. ALCOHOL FOR FUEL USE RECEIVED FROM
CUSTOMS CUSTODY
7. GAINS
8. TOTAL - LINES 1 THROUGH 7
9. BOTTLED OR PACKAGED
10. WINE MIXED WITH SPIRITS
11. USED FOR DENATURATION
12. TRANSFERRED IN BOND
13. WITHDRAWN TAX DETERMINED
15. WITHDRAWN WITHOUT PAYMENT OF TAX:
FOR ADDITION TO WINE
16. FOR EXPORTATION & TRANSFER TO C.B.W.
17. TRANSFERRED TO PRODUCTION ACCOUNT
FOR REDISTILLATION
14. WITHDRAWN FREE OF TAX: FOR U.S., HOSPITAL,
SCIENTIFIC, OR EDUCATIONAL USE
18. WITHDRAWN FOR RESEARCH, DEVELOPMENT,
OR TESTING (Including Gov. samples)
19. DESTROYED
21.
23.
22.
24. LOSSES
25. ON HAND END OF MONTH
26. TOTAL - LINES 9 THROUGH 25
20. USED FOR REDISTILLATION
TTB F 5110.28 (03/2016)
27. ON HAND FIRST OF MONTH
28. BOTTLED OR PACKAGED
29. RECEIVED
30. INVENTORY OVERAGES
31. TOTAL - LINES 27 THROUGH 30
32. TRANSFERRED IN BOND
33. WITHDRAWN TAX DETERMINED
34. WITHDRAWN FREE OF TAX: FOR U.S. HOSPITAL,
SCIENTIFIC, OR EDUCATIONAL USE
35. WITHDRAWN WITHOUT PAYMENT OF TAX:
FOR ADDITION TO WINE
36. FOR EXPORTATION, VESSELS, AND AIRCRAFT,
AND TRANSFER TO C.B.W.
37. TRANSFERRED TO PRODUCTION ACCOUNT
FOR REDISTILLATION
38. WITHDRAWN FOR RESEARCH, DEVELOPMENT,
OR TESTING (Including Gov. samples)
39. DESTROYED
40. DUMPED FOR FURTHER PROCESSING
41.
42.
43.
44. RECORDED LOSSES
45. INVENTORY SHORTAGES
46. ON HAND END OF MONTH
47. TOTAL - LINES 32 THROUGH 46
1
Bottled nonindustrial (beverage) use spirits may not be received or transferred in bond.
4. LOCATION OF PLANT
1
PART III - PUERTO RICAN AND VIRGIN ISLANDS SPIRITS (RUM) AND "OTHER" IMPORTED RUM
1
48. PROOF GALLONS REMOVED TAXPAID OR TAX DETER-
MINED
(a) PUERTO RICAN SPIRITS
(b) VIRGIN ISLANDS SPIRITS (c) "OTHER" IMPORTED RUM
KIND
PART IV - PROCESSING OF BEVERAGE (Nonindustrial use) SPIRITS
(a)
BULK SPIRITS DUMPED
INTO PROCESSING
2
(Whole proof gallons)
(b)
BOTTLED - IMPORTED
3
(Whole proof gallons)
(c) (d)
BOTTLED
(Excluded bottled in bond
and export)
(Whole wine gallons)
BOTTLED IN BOND
4
27 CFR 5.42(b)
(Exclude export)
(Whole wine gallons)
(e)
BOTTLED
FOR EXPORT
(Whole wine gallons)
(f)
49. ALCOHOL AND NEUTRAL SPIRITS (Other than vodka)
50. BLENDED STRAIGHT WHISKEY
5
51. BLENDED WHISKEY:
a. With neutral spirits
6
b. With light whiskey
7
52. BLENDED LIGHT WHISKEY
8
53. ANY OTHER BLENDS OF 100% WHISKEY
a. Scotch
b. Canadian
c. Irish and Others
55. DOMESTIC WHISKEY DISTILLED AT 160° AND UNDER
54. IMPORTED WHISKEY:
56. DOMESTIC WHISKEY DISTILLED AT OVER 160°
57. BRANDY DISTILLED AT 170° AND UNDER
58. BRANDY DISTILLED AT OVER 170°
59. SPIRITS (Rum)
1
60. RUM
a. Puerto Rican
1b. Virgin Islands
b. "Other" Imported
61. GIN
62. VODKA
63. CORDIALS, LIQUEURS, AND SPECIALTIES9
64. COCKTAILS AND MIXED DRINKS
65. TEQUILA
66.
a. Domestic
67. TOTAL - LINES 49 THROUGH 66
UNDER PENALTIES OF PERJURY, I DECLARE that I have examined this report and, to the best of my knowledge and belief, it is a true and complete report.
DATE PROPRIETOR BY
(Signature and Title)
4
Bottled in bond spirits are those that conform to the standard prescribed by 27 CFR 5.42(b) and are
labeled with the words "bond," "bottled in bond," "aged in bond," or similar phrases. Do not include
imported spirits.
5
Blends of straight whiskies, all of which are 2 years old or older; no neutral spirits; no light whiskey.
6
Blended whiskey, containing at least 20% straight whiskey, and the balance, neutral spirits.
7
Blended whiskey containing at least 20% straight whiskey, and the balance, light whiskey.
8
Light whiskey blended with more than 2% but less than 20% straight whiskey; no neutral spirits.
9
Includes flavored whiskies, gins, vodkas, brandies, etc.
1
Only products containing at least 92% RUM should be recorded at line 48(a) and (b), and at lines 59
a and b.
2
Do not include spirits that have been previously reported as dumped on dump/batch records and
retained in processing (27 CFR 19.343).
3
Include spirits from Puerto Rico and Virgin Islands. Imported spirits that are not allowed to be
labeled as a product of a foreign country, Puerto Rican, or Virgin Islands spirits under 27 CFR Part 5
must be reported as domestic spirits.
TTB F 5110.28 (03/2016)
PART IV – PROCESSING OF BEVERAGE (Nonindustrial use) SPIRITS
PAPERWORK REDUCTION ACT NOTICE
This information request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is to monitor the operation of
industries regulated by TTB. The information is required to verify unusual activities, errors, and omissions on taxable commodities. The information is
mandatory by statute. (26 U.S.C. 5207).
The estimated average burden associated with this collection of information is 2 hours per respondent or recordkeeper, depending on individual circum-
stances. 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 repond to, a collection of information unless it displays a current, valid OMB control
number.
TTB F 5110.28 (03/2016)