Form Ttb F 5100.16 - Application To Receive Spirits And/or Denatured Spirits By Transfer In Bond

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OMB No. 1513-0038 ( 1/3 /20
)
DEPARTMENT OF THE TREASURY
1. SERIAL NUMBER (Begin with
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)
“1” each January 1)
APPLICATION
SPIRITS AND/OR
DENATURED SPIRITS BY TRANSFER IN BOND
D
(See instructions below.)
PART I - APPLICATION
APPLICATION IS MADE FOR TRANSFER OF SPIRITS AND/OR DENATURED SPIRITS IN BOND, AS INDICATED BELOW
2. TO BE TRANSFERRED
3. TRANSFERS WILL BE RECEIVED AT:
a. PLANT NUMBER
b. ADDRESS
SPIRITS
DENATURED SPIRITS
4. TRANSFERS WILL BE MADE FROM:
a. PLANT NUMBER
b. ADDRESS
c. OPERATED BY
5. BOND INFORMATION (Complete 5a., plus 5b. or 5c.)
a. APPROVAL DATE OF MY
b.
I HAVE MAXIMUM BOND COVERAGE
c.
I HAVE LESS THAN MAXIMUM BOND
BOND (TTB F 5110.56) IS:
UNDER 27 CFR 19.245 - NO LIMIT TO
COVERAGE UNDER 27 CFR 19.245. MY
AMOUNT OF SHIPMENTS
AMOUNT OF OPERATIONS COVERAGE IS:
$
6. SHIPMENT INFORMATION (Complete 6a. and/or 6b. below ONLY IF 5c. ABOVE IS CHECKED)
a.
QUANTITY OF SPIRITS AUTHORIZED TO BE TRANS-
b.
QUANTITY OF DENATURED SPIRITS AUTHORIZED TO BE
FERRED (Computation: Amount shown in 5c. above divided
TRANSFERRED (Computation: Amount shown in 5c. above
by $13.50 per proof gallon):
divided by $27.00 per wine gallon):
PROOF GALLONS
WINE GALLONS
THE
PROPRIETOR IS RESPONSIBLE FOR ENSURING THAT THE LIABILITY ON ALL SPIRITS
IMPORTANT
DENATURED SPIRITS “ON HAND” AND “IN TRANSIT” WILL NOT EXCEED THE BOND COVERAGE AS
NOTICE
SHOWN IN 5c. ABOVE.
7. REMARKS
8. DATE
9. PROPRIETOR
10. BY (Signature and Title)
PART II - APPROVAL
I certify the penal sum of the applicant’s bond is sufficient to cover the spirits and/or denatured spirits indicated. APPLICATION IS APPROVED.
12. SIGNATURE OF DIRECTOR, NATIONAL REVENUE CENTER
11. DATE
TTB F 5100.16 (
/200

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