Ttb F 5630.5r Special Tax "Renewal" Registration And Return Form 2008 Page 3

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OMB NO. 1513-0113 (02/29/2008)
DEPARTMENT OF THE TREASURY
TAX
2008
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
SPECIAL TAX LOCATION REGISTRATION LISTING
YEAR
PRMT
(RENEWAL BUSINESS - TAX PERIOD 7/1/2007 – 6/30/2008)
EMPLOYER IDENTIFICATION NUMBER:
TTB
TAX
BUSINESS
CITY,
LOCATION
CLASS
TRADE NAME
LOCATION ADDRESS
TELEPHONE
STATE, ZIP CODE
NUMBER
CODE
NUMBER
DO NOT WRITE IN THE SPACE BELOW EXCEPT TO ADD A NEW BUSINESS LOCATION
TRADE NAME
BUSINESS TELEPHONE NUMBER
(
)
LOCATION ADDRESS
CITY, STATE, ZIP CODE
TAX CODE
TAX CLASS
DATE NEW LOCATION STARTED BUSINESS (mm/dd/yyyy)
TTB F 5630.5R (2008) (06/2007)
(Page 3 of 3)

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