Form Ttb F 5154.2 - Supporting Data For Nonbeverage Drawback Claims - 2016 Page 2

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PAGE
OF
PART III - PRODUCTION OF NONBEVERAGE PRODUCTS
ELIGIBLE SPIRITS USED
FINSHED PRODUCT PRODUCED
INFORMATION FROM TTB FORM 5154. 1
INELIGIBLE
RECOVERED
AMOUNT PRODUCED
NAME OF
FORMULA NO. (or
AMOUNT USED
ALCOHOL
KIND (P.R. or V.I.
DRAWBACK RATE
SPIRITS USED
(wine gals., except
PRODUCT
CONTENT BY
“NF,” “USP” or
spirits, imported
(= $1.00 less than
(proof gals.)
(proof gals.)
dry products)
VOLUME
“HPUS”)
rum, other kinds)
effective tax rate)
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
1.
$
%
2.
$
%
3.
$
%
4.
$
%
5.
%
$
6.
%
$
7.
$
%
8.
$
%
9.
$
%
10.
$
%
11.
$
%
12.
$
%
13.
$
%
14.
$
%
PART IV - ADDITIONAL AND EXPLANATORY INFORMATION
I certify, under the penalties of perjury, that the data submitted
SIGNATURE AND TITLE
DATE
on this form are correct, to the best of my knowledge.
TTB F 5154.2 (11/2014)

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