Form TTB F 5110.43 TTB F 5110.43 Monthly Report of Processing (Denaturing) Operations

OMB No. 1513-0049 (09/30/2006)

DEPARTMENT OF THE TREASURY

MONTH AND YEAR

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

MONTHLY REPORT OF PROCESSING (DENATURING) OPERATIONS
NAME OF PROPRIETOR

LOCATION OF PLANT

PLANT NUMBER
DSP-

SECTION I - DENATURED SPIRITS
TRANSACTION

(a)

COMPLETELY
DENATURED
ALCOHOL
(b)

WINE GALLONS
SPECIALLY
DENATURED
ALCOHOL
(c)

SPECIALLY
DENATURED
RUM
(d)

SECTION II - RECOVERED DENATURED SPIRITS AND RECOVERED ARTICLES RECEIVED
FOR RESTORATION AND/OR REDENATURATION UNDER 27 CFR 19.6831 AND RECOVERED
DENATURED SPIRITS AND RECOVERED ARTICLES ON MY BONDED PREMISES RECEIVED
FOR RESTORATION AND/OR REDENATURATION.
WINE GALLONS
TRANSACTION

1. On hand first of month
2. Produced
3. Rec’d by transfer in bond3
4.
5. TOTAL, Lines 1-4
6.
7.
8.
9.

To dlrs. & users (exc. U.S. & Line 10)
For use of U.S. (exc. Line 10)
Transferred in bond
For use in mfg. of articles on
my bonded premises
10. Withdrawn for fuel use
11. Losses
12. On hand end of month

(a)

RECOVERED
DENATURED
SPIRITS
(b)

RECOVERED
ARTICLES
(c)

15. On hand first of month
16. Received
17. Increase due to redenaturation
18.
19. TOTAL, Lines 15-18

20. Shipped
21.
22. Losses
23. On hand end of month
13.
14. TOTAL, Lines 6-13
24. TOTAL, Lines 20-23
SECTION III - WINE GALLONS OF DENATURED SPIRITS WITHDRAWN DURING FISCAL YEAR ENDING
Under penalties of perjury, I declare that I have examined this
2
JUNE 30, 20
report and, to the best of my knowledge and belief, it is a true
and complete report of denaturing operations.
FORMULA COMPLETELY
SPECIALLY
SPECIALLY
FORMULA
SPECIALLY
FORMULA
FORMULA
PROPRIETOR
NUMBER
DENATURED
DATE
DENATURED
DENATURED
NUMBER
DENATURED
NUMBER
NUMBER
ALCOHOL
ALCOHOL
ALCOHOL
ALCOHOL
20
18
35-A
44
BY (Signature and title)
22
19
36
45
23-A
20
37
46
23-F
TOTAL
38-B
INSTRUCTIONS
23-H
38-C
Specially Denatured Alcohol
1. Each proprietor of a distilled spirits plant who is authorized to process,
25
including the denaturing of spirits, must prepare the form in duplicate monthly,
1
38-D
forward the original to the Director, National Revenue Center, 550 Main St.,
25-A
2-B
38-F
Ste. 8002, Cincinnati, OH 45202-5215, no later than the 15th day of the month
27
2-C
39
following the month for which prepared, and retain a copy for his or her files.
27-A
3-A
39-A
2. Section III is to be completed only on the report for the month of June or on
27-B
3-B
39-B
Special Formulas
the Proprietor’s final report on permanent discontinuance of business.
28-A
4
39-C
FOOTNOTES
29
6-B
39-D
1/
Do not include recovered denatured spirits and articles returned for
30
12-A
40
redistillation under 27 CFR 19.683. Such products should be reported on
TOTAL
31-A
F 5110.40, Monthly Report of Production Operations.
13-A
Specially Denatured
40-A
SpeciallyRum
Denatured Rum TTB
2/
Do not include denatured spirits transferred in bond to other bonded
32
17
40-B
4
premises.
33
18
3/
40-C
Imported denatured spirits received from Customs custody for fuel use should
35
be
reported separately on line 4.
19
42
TTB F 5110.43 (8/2006)

PAPERWORK REDUCTION ACT NOTICE

This information request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is to monitor the operations of industries regulated by TTB. The
information is required to verify unusual activities, errors, or omissions on taxable commodities. The information is required by statue (26 U.S.C. 5207). This information collection must be
retained for 3 years.
The estimated average burden associated with this collection of information is 1 hour per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of
this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade
Bureau, Washington, DC 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number.

TTB F 5110.43 (8/2006)