Form Ttb F 5100.16 - Application For Transfer Of Spirits And/or Denatured Spirits In Bond
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1
2OMB No. 1513-0038 (01/31/2013)
1. Serial Number
DEPARTMENT OF THE TREASURY
(Begin with “1” each January 1)
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
APPLICATION FOR TRANSFER OF SPIRITS AND/OR
YEAR
SERIAL #
DENATURED SPIRITS IN BOND
20
(See instructions on the back of this form. See 27 CFR 19.505-510)
PART I - APPLICATION
APPLICATION IS MADE FOR TRANSFER OF SPIRITS AND/OR DENATURED SPIRITS IN BOND, AS INDICATED BELOW.
*
Each Proprietor is responsible for ensuring that transferred products are suitable for use in their qualified plant operations.
SHIPPING DISTILLED SPIRITS (DSP) PLANT
ALCOHOL FUEL PRODUCER (AFP)
OR
2.
This plant will transfer
spirits
denatured spirits to the receiving plant listed in Item 5.
3a. Registry /Permit Number
3b. Shipping DSP/AFP Company Name
3c. Shipping DSP/AFP Premises Address
DSP -
-
AFP -
-
4.
The transferring plant has, at the location listed above, the following type(s) of permit(s) *:
An FAA Act BASIC PERMIT authorizing distilling, warehousing, processing and/or bottling of NON-INDUSTRIAL (BEVERAGE) SPIRITS
An OPERATING PERMIT authorizing
Warehousing bulk spirits for NON-INDUSTRIAL (BEVERAGE) use
Distilling, warehousing, and/or bottling or packaging spirits for INDUSTRIAL use
Denaturing spirits
Manufacturing articles
An ALCOHOL FUEL PRODUCER PERMIT
RECEIVING DISTILLED SPIRITS PLANT (DSP)
5a. Registry Number
5b. Receiving DSP Company Name
5c. Receiving DSP Premises Address
DSP -
-
The receiving plant has the following bond coverage
(Complete 6a and 6b, or 6a and 6c)
6a. “DATE APPROVED”
6b. I have maximum OPERATIONS bond
6c. I have less than maximum OPERATIONS bond
coverage under 27 CFR 19.166 – no
coverage under 27 CFR 19.166. The amount of
from TTB F 5110.56, DSP Bond
limit to amount of shipments
my OPERATIONS coverage is:
(bottom of bond page 2)
$
(Complete 7a and/or 7b below only if 6c is selected.)
Quantity of Spirits Authorized to be Transferred
Quantity of Denatured Spirits Authorized to be Transferred
7a.
7b.
(Computation: Amount shown in 6c above divided by $13.50 per
(Computation: Amount shown in 6c divided by $27.00 per wine gallon):
proof gallon):
PROOF GALLONS
WINE GALLONS
IMPORTANT
The receiving proprietor is responsible for ensuring that the liability on all spirits and denatured spirits “on hand” and “in
NOTICE
transit” will not exceed the bond coverage as shown in 6c above.
8.
Remarks:
9.
Date
10. Name and Title of Authorized Person for Receiving Plant
11. Receiving Proprietor Signature
PART II – TTB APPROVAL
I certify that the penal sum of the applicant’s bond is sufficient to cover the spirits and/or denatured spirits indicated. APPLICATION IS APPROVED.
12. Date
13. Signature of Director, National Revenue Center
TTB F 5100.16 (10/2010)
PREVIOUS EDITIONS ARE OBSOLETE
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