Form Atf F 1582-B - Drawback On Beer Exported

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OMB No. 1512-0083 (10/31/2001)
DEPARTMENT OF THE TREASURY
1. SERIAL NUMBER (The exporter
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
will number each from beginning
DRAWBACK ON BEER EXPORTED
with "1" each January 1.)
(Prepare in quadruplicate, see instructions on back of this form)
PART I - NOTICE
FOR TECHNICAL SERVICES
NOTICE IS HEREBY GIVEN OF THE SHIPMENT OF TAXPAID BEER ON WHICH DRAWBACK OF INTERNAL
USE ONLY
REVENUE TAX PAID THEREON WILL BE CLAIMED BY THE PRODUCING BREWER.
CLAIM NUMBER
2. NAME AND ADDRESS OF EXPORTER (Number, street , city, State and ZIP Code)
DATE RECEIVED
3. NAME AND ADDRESS OF PRODUCING BREWER
3a. EMPLOYER IDENTIFICATION
1
NUMBER
FORM 5620.5 FILED WITH CLAIM
NO.
2
4 . ADDRESS OF THE CHIEF, TECHNICAL SERVICES,
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS FOR THE
AMOUNT CLAIMED
DISTRICT IN WHICH PRODUCING BREWER IS LOCATED
$
(Location)
5. PURPOSE
SHIPMENT FOR EXPORT
(Number)
TRANSFER TO
AMOUNT REJECTED
OF
TO ARMED FORCES
FOREIGN-TRADE
$
SHIP-
OF THE U.S.
ZONE
MENT
EXPORTATION TO (Name of foreign port and country)
AMOUNT APPROVED
(Make
$
applicable
USE AS SUPPLIES ON
CLAIMS CLERK
entries)
A VESSEL
3
AIRCRAFT
3
DIRECTOR OF CUSTOMS AT PORT OF
7. NAME OF DOMESTIC CARRIER
6. CON-
SIGNED
TO OR IN
(Name)
(Location)
TRANSPORTATION
CARE OF
OFFICER
8. NAME OF EXPORT CARRIER
(Make
CUSTOMS OFFICER IN
applicable
(Location)
(Number)
CHARGE OF FOREIGN-TRADE
entries)
ZONE
9. THE BEER WAS SHIPPED IN THE FOLLOWING CONTAINERS (Show container size as "1/4 bbl", "24/12", etc.)
NUMBER
KIND
NUMBER
KIND
SIZE
KIND
SIZE
NUMBER
SIZE
(d)
(h)
(f)
(g)
(i)
(a)
(b)
(c)
(e)
10. DATE
11. EXPORTER
11a. BY (Signature and title)
PART II - CLAIM
TO: CHIEF, TECHNICAL SERVICES, BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
The beer described in Part I has been removed for the purpose stated and is not to be brought back or remanded within the limits of the United States. The
quantity of beer, as described in Part I and restated below in terms of barrels, is correct, and such beer was brewed or produced in the United States. I am
justly entitled to drawback of tax in the amount claimed herein. Internal revenue tax equal to such amount has been determined and paid as provided by law
and regulations. No other claim for allowance of drawback has been made on this beer or any part thereof.
13. QUANTITY OF BEER (Barrels)
14a. RATE OF TAX
4
12. DATE
14b. DRAWBACK CLAIMED
$7
$18
$
Under penalties of perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the statements herein and
in Part I are true, correct, and complete.
1
15a. BY (Signature and title)
15. BREWER
1
The producing brewer must always complete item 3a.
2
Complete only for consolidated claims; show serial number of last claim tabulated.
3
State whether (a) Vessel or aircraft operated by the United States; (b) Vessel or aircraft engaged in foreign trade, or in trade between the United States and
any of its possessions, or between Hawaii or Alaska and any other part of the United States; (c) Vessel of the United States engaged in trade between
Atlantic and Pacific ports of the United States; (d) Vessel of war of any foreign nation; or (e) Vessel employed in (1) the fisheries, or (2) The whaling
business. Show name of vessel, country of registry, and ports of call, or, if a whaling vessel, location or operations. If aircraft, show also name of airline
and country of registry of aircraft.
4
Indicate the rate of tax paid on the beer which was exported. If the beer was produced by a brewer qualified under 27 CFR 25.152 to pay tax at the
reduced rate of tax, drawback shall be claimed at the lower rate of tax unless the brewer or the brewer's agent can establish that the beer was taxpaid at
the higher rate of tax.
ATF F 1582-B (5130.6) (1-98) PREVIOUS EDITIONS ARE OBSOLETE

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