DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
REPORT OF WINE PREMISES OPERATIONS
PERIOD
MONTH _______________ YEAR ________________________
(If applicable)
REGISTRY NUMBER
OPERATED BY (Name, Address and Telephone)
INSTRUCTIONS
1. The reporting period for this form shall be monthly, except that proprietors who qualify under
the exception stated in 27 CFR 24.300 (g)(2) may file this form on a calendar year basis unless
required to file monthly by the Alcohol and Tobacco Tax and Trade Bureau (TTB). A proprietor
who files monthly reports but does not expect any reportable operations in a subsequent month
or months may indicate in Part X that no monthly reports will be filed until a reportable operation
occurs. (§24.300 (g)(1))
2. Prepare this form in duplicate and file it by the fifteenth day after the end of the report period
(month or year)
. Keep the copy on your bonded wine premises for inspection by TTB officers.
Send the original to TTB at this address:
Director, National Revenue Center
Alcohol and Tobacco Tax and Trade Bureau
550 Main St, Ste 8002
Cincinnati, OH 45202-5215
PART I - SUMMARY OF WINES IN BOND (GALLONS)
ITEM
ALCOHOL CONTENT BY VOLUME
NOT OVER 14
PERCENT
(a)
OVER 14 TO 21 PERCENT
(Inclusive)
(b)
OVER 21 TO 24 PERCENT
(Inclusive)
(c)
ARTIFICIALLY
CARBONATED
WINE
(d)
SPARKLING WINE
(e)
SECTION A - BULK WINES
1. ON HAND BEGINNING OF PERIOD
2. PRODUCED BY FERMENTATION
1/
BF
BP
3. PRODUCED BY SWEETENING
4. PRODUCED BY ADDITION OF WINE SPIRITS
5. PRODUCED BY BLENDING
6. PRODUCED BY AMELIORATION
7. RECEIVED IN BOND
8. BOTTLED WINE DUMPED TO BULK
10.
11.
9. INVENTORY GAINS
13. BOTTLED
2/
14. REMOVED TAXPAID
15. TRANSFERS IN BOND
16. REMOVED FOR DISTILLING MATERIAL
17. REMOVED TO VINEGAR PLANT
18. USED FOR SWEETENING
19. USED FOR ADDITION OF WINE SPIRITS
20. USED FOR BLENDING
4/
21. USED FOR AMELIORATION
22. USED FOR EFFERVESCENT WINE
23. USED FOR TESTING
24.
25.
26.
27.
28.
29. LOSSES (OTHER THAN INVENTORY)
30. INVENTORY LOSSES
31. ON HAND END OF PERIOD
32. TOTAL
SECTION B - BOTTLED WINES
1. ON HAND BEGINNING OF PERIOD
BF
BP
2. BOTTLED
2/
3. RECEIVED IN BOND
4. TAXPAID WINE RETURNED TO BOND
5.
6.
8. REMOVED TAXPAID
9. TRANSFERRED IN BOND
10. DUMPED TO BULK
11. USED FOR TASTING
12. REMOVED FOR EXPORT
13. REMOVED FOR FAMILY USE
14. USED FOR TESTING
15.
16.
17.
18. BREAKAGE
19. INVENTORY SHORTAGE
3/
20. ON HAND END OF PERIOD
21. TOTAL
7. TOTAL
TTB F 5120.17 (5/2005)
1/
Enter in col. (e) on line marked "BF" the quantity of sparkling wine produced by fermentation in bottles, and on line mark "BP" the quantity of sparkling wine produced by bulk process.
2/
Section A line 13 and Section B line 2 should show the same quantities. Enter in col. (e) on line marked "BF" the quantity of finished bottle fermented sparkling wine bottled, and on line marked "BP" the quantity of finished bulk process wine
bottled.
3/
Fully explain in either Part X, or on a separate signed statement submitted with this report. Failure to satisfactorily explain shortages of bottled wine may result in the assessment of taxes applicable to those shortages.
4/
Only report blending if wines of different tax classes are blended together.
BP
BF
12. TOTAL
HARD CIDER
(f)
3. Explain any unusual operations in Part X.
4. The quantities "on hand end" will ordinarily be "book inventory" figures, that is the quantity
required to balance each summary. Use the "on hand end" from your report for the previous period
as the "on hand beginning" of the current report. On reports for any period when you take a
physical inventory, report the difference as losses for bulk wine and shortages for bottled wine, or as
gains, as the case may be.
5. If the quantity of wine previously reported on TTB F 5120.17 is affected by adjustments made on
a tax return, TTB F 5000.24, adjust the current TTB F 5120.17 in Section A
(and Section B, if
bottled wine is involved)
. Explain the entries in Part X.
OMB No. 1513-0053 (8/31/2005)
Operating Name of Wine Premises
Address
Telephone Number
EIN: 99-999999x
