Form Atf F 5620.7 - Claim For Drawback Of Tax On Tobacco Products, Cigarette Papers And Cigarette Tubes

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OMB No. 1512-0117 (09/30/2002)
DEPARTMENT OF THE TREASURY
FOR ATF USE ONLY
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
CLAIM NUMBER
DATE OF AUDIT
CLAIM FOR DRAWBACK OF TAX ON TOBACCO PRODUCTS, CIGARETTE
PAPERS AND CIGARETTE TUBES
AUDITED BY
(See Instructions on back)
PART I - REQUEST FOR INSPECTION
1. CHECK ONE
These articles taxpaid under
These articles taxpaid under
These articles taxpaid under
26 U.S.C. 5701. (Produced in
26 U.S.C. 7652(a). (Produced
26 U.S.C. 7652(b). (Brought
U.S.A. or a foreign country)
in Puerto Rico)
in from U.S. Virgin Islands)
2. TO BE SHIPPED TO (Name and Address)
TO:
National Revenue Center
Bureau of Alcohol, Tobacco and Firearms
8002 Federal Office Building
550 Main Street
Cincinnati, Ohio 45202-3263
I request that an officer of the Bureau of Alcohol, Tobacco and Firearms be assigned to inspect tobacco products, cigarette papers, or cigarette tubes, on
which I have paid the tax, and which are to be shipped to a foreign country, Puerto Rico, the U.S. Virgin Islands, or a possession of the United States
with benefit of drawback of tax, as provided for by the regulations in 27 CFR, Part 290.
3. LOCATION WHERE ARTICLES ARE HELD (Number, street, city or town, State and ZIP Code)
4. NAME AND MAILING ADDRESS OF TAXPAYER (Street address, P.O. Box or R.F.D. number, city, State and ZIP Code)
5. SIGNATURE OF TAXPAYER (if officer of corporation, give title)
6. TAXPAYER’S EMPLOYER IDENTIFICATION
7. DATE
NUMBER
PART II - CLAIM
8. SCHEDULE OF ARTICLES FOR EXPORT
NUMBER
KIND OF
SALE
NUMBER OF
TOTAL
TOTAL PRICE
2
RATE
AMOUNT
MARKS &
OF
ARTICLES
PRICE
POUNDS/
NUMBER
Col. (d) x Col. (f) ÷
OF TAX
OF TAX
NUMBERS ON
CONTAINERS
(Small cigarettes,
PER 1,000
1
OUNCES IN
OR POUNDS/
1,000
CLAIMED
SHIPPING
CONTAINERS
Large cigars, Chewing
EACH
OUNCES
Tobacco, Snuff, etc.)
CONTAINER
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
ROLL-YOUR-OWN TOBACCO
PIPE TOBACCO
CIGARS
TOTAL
$
CIGARETTES
CHEWING TOBACCO
SNUFF
1
Complete only for large cigars. Enter the taxable sale price per thousand.
2
Complete only for large cigars with a sale price of not more than $235.294 per thousand.
Under penalties of perjury I declare that this claim for drawback of internal revenue tax is, to the best of my knowledge and belief, true and accurate; I
have paid the tax on the tobacco products, cigarette papers, or cigarette tubes, to be shipped to a foreign country, Puerto Rico, the U.S. Virgin Islands, or
a possession of the United States, or to foreign-trade zone; no other allowance of drawback has been made or claimed on the tobacco products,
cigarette papers, or cigarette tubes or any part thereof; and I am justly entitled to a drawback of tax.
9. SIGNATURE OF CLAIMANT
11. DATE
10. TITLE OR STATUS (State whether individual owner, member
of firm, or if officer of corporation, give title)
PART III - ATF OFFICER’S REPORT OF INSPECTION
I have inspected the articles and find that Part II, Item 8, is complete and accurate; the packages of tobacco products, cigarette papers, or cigarette tubes,
have attached thereto the required label; the articles were packed under my supervision in shipping containers; and each container has been marked and
numbered, as indicated in Part II, Item 8, and released to the claimant for export.
ATF F 5620.7 (11-99) (Formerly ATF F 2147 (5620.7), which is obsolete)

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