Form Ttb F 5220.4 - Report - Proprietor Of Export Warehouse Page 3

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OMB NO. 1513-0024 (01/31/2013)
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
AUDITED BY
DATE OF AUDIT
REPORT - PROPRIETOR OF EXPORT WAREHOUSE
1. Employer Identification Number
2. TTB Permit Number
3. Report Covers Period of:
4.
This is the first report for this export
(Read instruction F)
(Read instruction G)
(Read instruction H)
warehouse.
―
5.
This is a final report and I have attached my
permit OR my permit is not attached
6. Name and Address (as listed on TTB permit)
because:
Large Cigarettes
Small Cigarettes
Chewing Tobacco
* Enter quantity in pounds and fractions of
Large Cigars (Number)
Small Cigars (Number)
(Number)
(Number)
(Pounds)*
a pound rounded to 2 decimal places.
(a)
(b)
(c)
(d)
(e)
7. On Hand Start of Period
a. From factories of manufacturers
8.
b. From Customs custody
NO ENTRY
NO ENTRY
NO ENTRY
NO ENTRY
NO ENTRY
(1) Puerto Rico
(2) Other
c. From other export warehouses
d. From Foreign Trade Zones
9. Overages Disclosed by Inventory
10. Other (Specify):
11. TOTAL
12.
a. To other export warehouses
b. To factories of manufacturers
c. To Foreign Trade Zones
d. Other exports
13. Loss Other Than Shortage by
Inventory (Read instruction I)
14. Shortages Disclosed by Inventory
(Read instruction J)
15. Other (Specify):
16. On Hand End of Period
17. TOTAL
TTB F 5220.4 (05/2009) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 1 of 2

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