Form Ttb F 5220.4 - Report - Proprietor Of Export Warehouse Page 4

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Roll-Your-Own
* Enter quantity in pounds and
Processed Tobacco
Snuff
Pipe Tobacco
Tobacco
Cigarette Papers
Cigarette Tubes
fractions of a pound rounded to 2
(Pounds)*
(Pounds)*
(Pounds)*
(Pounds)*
(Number)
(Number)
decimal places.
(f)
(g)
(h)
(i)
(j)
(k)
7. On Hand Start of Period
8.
a. Fro m factories of
manufacturers
b. From Customs custody
NO ENTRY
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
UNDER PENALTIES OF PERJURY, I DECLARE THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS REPORT IS TRUE, ACCURATE, AND COMPLETE.
18. Signature
19. Name and Title
20. Business Telephone Number
21. Business E-Mail Address
Send this form to the Director, TTB National Revenue Center, 550 Main St., Ste. 8002, Cincinnati, OH 45202-5215
TTB F 5220.4 (05/2009) PREVIOUS VERSIONS SUPERSEDED AND MAY NOT BE USED
Page 2 of 2

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