Form Ttb F 5200.3 - Application For A Permit As A Manufacturer Of Tobacco - Department Of The Treasury

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OMB No. 1513-0078 (12/31/2008)
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
Number
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR A PERMIT AS A MANUFACTURER OF TOBACCO
Date
PRODUCTS OR AN EXPORT WAREHOUSE PROPRIETOR
1. I am applying for a TTB permit to conduct business as a:
OR
Proprietor of an Export Warehouse
Manufacturer of Tobacco Products
2. I am applying because:
I am starting a new business as stated in item 1.
I am taking ownership of an existing business as of
(enter date) and have attached their TTB
permit; or,
if the permit is not available, their name and their TTB permit number are
There has been a change in control in the corporation of the business as of
(enter date), and I have attached
their TTB permit. If the permit is not available, state their name and TTB permit number:
3. My legal name is (Read instruction H):
4. My employer identification number is (Read instruction I) :
5. My trade name or names are (Read instruction J):
6.
I have attached my trade name(s) certificate(s) (Read instruction K)
OR
I have NOT attached these certificates for the following reason:
7. The mailing address for my factory as a manufacturer of tobacco products or export warehouse is: (Note: TTB will use this address to
correspond with you.)
8.
I have attached a description and, if necessary, a diagram of my factory or export warehouse (Read instruction L)
OR
I have NOT attached a description for the following reason:
9.
I have attached the documents of my business as required by instruction M.
OR
I have NOT attached documents for my business for the following reason:
10.
I have provided the information about each person (Read instructions N and O) on this form or as an attachment.
OR
I have NOT provided this information for the following reason:
a. Full Legal Name
b. Title and position in my business
c. Percent (%) of voting stock or interest held in my business as a
d. Dollar amount of investment in my business as a manufacturer of
manufacturer of tobacco products or an export warehouse proprietor.
tobacco products or as an export warehouse proprietor.
Do NOT include stock held by a corporation to determine the percent
Anticipated:
Current:
of voting stock.
$
$
f. Reason for, or source of, investment. For example: savings, loan,
e. Name and address of the person(s) from whom the investment
profits from other business, or gift
comes
TTB F 5200.3 (10/2006)
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