Form Ttb F 5100.18 - Application For Amended Basic Permit Under The Federal Alcohol Administration Act 2010 Page 2

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INSTRUCTIONS

3. INFORMATION ON FILE. You may reference information if you filed it

1. GENERAL. File this application if you want to amend your permit under

with a valid TTB permit or an application that is pending with TTB.

the Federal Alcohol Administration Act (FAA Act) or to notify the Alcohol

Reference the appropriate item(s) of this application. Include the name

and Tobacco Tax and Trade Bureau (TTB) of a change in the owner-

of the applicant or the permittee, and the TTB permit number or the type

ship, management, or control. In the case of a corporation, report any

and date of the application.

change in the officers, directors, or persons (individual or business)

who own or control more than 10 percent of the voting stock. When a

4. OPERATIONS WITHOUT AN AMENDED PERMIT. In general, criminal

change results in an actual or legal change in control or a new person

and administrative actions may be taken against persons operating

acquires a permittee’s business, file an application for a new permit

without a valid FAA Act permit. Before you conduct any operations with

(TTB F 5100.24). Neither the filing of this application nor its approval

any change specified in items 4 through 7, you must apply for, and

allows a business to violate State or local laws, such as registration of

receive, an approved permit. Immediately notify TTB of any changes

trade names and licensing requirements.

in the ownership or management in a permittee’s business.

2. FILING. Complete all applicable items. Attach your permit to this

. If you move or change

5. ITEM 5 -

application if you are requesting any amendments identified in items 4

the location of your business complete TTB F 5630.5d, Alcohol Dealer

through 7. If you need additional room, use a separate sheet. Put your

Registration within 30 days of the change. You do not need a TTB F

name, permit number(s), date of application, and the item number(s) on

5630.5d when your business only involves the importation or sale of

each separate sheet. File two copies of this form and any attachments

fermented cereal beverages which have an alcoholic content of less

with the appropriate TTB office listed below. Also, contact this office if

than 1/2 percent or where your business is only in Puerto Rico.

you have questions.

6. ITEM 11 AND 12 - SIGNING THE APPLICATION. If the permittee is an

individual, the indvidual must sign. If the permittee is a corporation, the

Location of

Send to:

president, vice-president, or other principal officer must sign. If the

Business on permit

TTB

Telephone Number

permittee is a partnership or other unincorporated organization, a

Director, Puerto Rico Operations

787-766-5584

responsible and authorized member or officer having knowledge

Ste 310 Torre Chardon

of its affairs must sign. If the permittee is a trust or estate, the fiduciary

350 Carlos Chardon Ave

must sign. If an agent of the permittee signs, file an acceptable power

San Juan, PR 00918-2124

of attorney (for example TTB F 5000.8) with the appropriate TTB office.

ALL OTHER STATES

TTB, National Revenue Center

1-877-882-3277

7. APPROVAL. If you complete any of items 4 through 7 and attach your

550 Main Street, Suite 8002

Cincinnati, OH 45202

permit, TTB will send the amended FAA Act permit to you. If you

complete item 8, TTB will return a copy of this application for your files.

PRIVACY ACT INFORMATION

The following information is provided pursuant to Sections 3 and 7(b) of the Privacy Act of 1974:

1. AUTHORITY. Solicitation of information on TTB F 5100.18 is made pursuant to 27 U.S.C. Section 204(c). Disclosure of this information by the

applicant is mandatory if the applicant wishes to obtain an amended basic permit under the FAA Act.

2. PURPOSES. To identify the permittee; the location of the premises; and to determine the eligibility of the permittee to obtain an amended basic permit.

3. ROUTINE USES. The information will be used by TTB to make determinations set forth in paragraph 2 above where such disclosure is not prohibited.

TTB officers may disclose this information to other Federal, State, foreign, and local law enforcement and regulatory agency personnel to verify

information on the application and for enforcement of the laws of such other agency. The information may be disclosed to the Justice Department if the

application appears to be false or misleading. TTB officers may disclose the information to individuals to verify information on the application where

such disclosure is not prohibited.

4. EFFECTS OF NOT SUPPLYING INFORMATION REQUESTED. TTB may delay or deny the issuance of the FAA Act basic permit where information is

missing or not complete.

5. DISCLOSURE OF EMPLOYER IDENTIFICATION NUMBER AND SOCIAL SECURITY NUMBER. You do not have to supply these numbers. These

numbers are used to identify an individual or business. If you do not supply these numbers, your application may be delayed.

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to determine the eligibility of the applicant to

engage in certain operations, to determine the location and extent of operations, and to determine whether the operations will conform to Federal laws

and regulations. This information is required to obtain a benefit and is mandatory by statute (27 U.S.C. 203 and 204(c)).

The estimated average burden associated with this information collection is 30 minutes per respondent or recordkeeper, 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, DC 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.

TTB F 5100.18 (01/2010)