Old TTB F 5620.8

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

OMB No. 1513-0030 (08/31/2005)
FOR TTB USE ONLY
CLAIM NUMBER

CLAIM - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU TAXES
1.

2.

3.

(File in duplicate with the Alcohol and Tobacco Tax and Trade Bureau)
PART I. TO BE FILLED IN BY CLAIMANT.
THIS CLAIM IS FILED UNDER THE PROVISIONS OF 27 CFR (Enter applicable section of regulations, such as 53, 270.283, 285.173. See
www.ttb.treas.gov )

REMISSION OF TAX

ALLOWANCE OF CREDIT FOR TAX

ABATEMENT OF TAX

ALLOWANCE OF LOSS

ALLOWANCE OF TAX

REFUND OF TAX

DRAWBACK-MNBP

DRAWBACK-EXPORT

OTHER (Specify)

NAME AND ADDRESS OF CLAIMANT (Telephone number and e-mail
address optional)

4.

EMPLOYER IDENTIFICATION NUMBER

5.

PLANT, LICENSE OR PERMIT NUMBER

6.

KIND OF TAX

7.

PERIOD, IF SPECIAL TAX OR MNBP (mm/dd/yy)

8.

FROM
TO
AMOUNT OF TAX CLAIMED

9.

DATE OF PAYMENT

10. BASIS OF CLAIM (Give the detailed information required by the applicable regulations under which the claim is filed and any other facts which will tell the
reviewing official of the exact basis for the claim. Please identify any documents or statements submitted in support of this claim.)

(Attach letter size sheets if more space is required)
Under the penalties of perjury, I declare that I have examined this claim, including supporting documents and statements, and to the best of my
knowledge and belief, it is true, correct and complete.
11. SIGNATURE (Type or print name and title under or beside signature)

TTB F 5620.8 (5/2005)

12. DATE

PART II. ACTION BY THE ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (To be returned to claimant)
13. YOUR CLAIM FOR
REMISSION OF TAX
ALLOWANCE OF CREDIT FOR TAX
ABATEMENT OF TAX
ALLOWANCE OF LOSS

ALLOWANCE OF TAX

DRAWBACK-MNBP
14. KIND OF TAX

REFUND OF TAX

DRAWBACK-EXPORT
15. TYPE OF CLAIM
FIREARMS AND/OR AMMUNITION
TOBACCO PRODUCTS
WITHDRAWN FROM MARKET
SPECIAL TAX
LOST/DESTROYED

DISTILLED SPIRITS
WINE
BEER

OTHER (SPECIFY)

OTHER (Specify)
OVERPAYMENT

OTHER (SPECIFY)

16. HAS BEEN ACTED ON AS INDICATED BELOW: 17. AUTHORIZATION: 26 U.S.C. SECTION
A. CLAIMED
QUANTITY OR PERIOD
(Proof gallons, wine
gallons, number)
(a)

B. ADJUSTMENT, SEE BELOW

AMOUNT
(b)

QUANTITY OR PERIOD
(Proof gallons, wine
gallons, number)
(c)

C. APPROVED

AMOUNT
(d)

QUANTITY OR PERIOD
(Proof gallons, wine
gallons, number)
(e)

AMOUNT
(f)

18. IF THIS IS A CLAIM FOR ALLOWANCE OF CREDIT, YOU MAY TAKE THE CREDIT ON TTB F 5000.24, EXCISE TAX RETURN OR TTB F 5000.25,
EXCISE TAX RETURN - ALCOHOL AND TOBACCO (PUERTO RICO). CREDIT FOR INTEREST IS NOT ALLOWABLE ON THIS CLAIM EXCEPT AS
INDICATED IN ITEM 19 BELOW.
19. EXPLANATION OF ADJUSTMENT

NOTE: If your claim was for abatement, your account will be adjusted accordingly. Please promptly submit your payment for any amount disallowed in Item
16B(d), plus any accrued interest, to TTB with a copy of the accompanying tax bill.
If your claim was for refund, your check will be forwarded under separate cover.
20. SIGNATURE AND TITLE OF APPROPRIATE TTB OFFICIAL

21. TTB OFFICE

22. DATE

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used, along with other supporting documents, to obtain
credit, remission and allowance of tax on taxable articles (alcohol, beer, tobacco products and firearms and ammunition) that have been lost and to obtain
refund of overpaid taxes and abatement of overassessed taxes. This information is required to obtain a benefit by 26 U.S.C. 5008, 5705 and 6416.
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 Reports Management
Officer, Regulations and Procedures 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 currently valid OMB control
nu mber.
TTB F 5620.8 (5/2005)

GENERAL INSTRUCTIONS
ITEM 1.

Enter the section of the regulations under which you are filing
this claim. You may refer to regulations listed on the TTB
website at www.ttb.treas.gov.

removal from the factory, but prior to the time for payment
of the tax, the articles are lost (other than by theft) or
destroyed by fire, casualty, or act of God.

ITEM 2.

Select the type of claim you are filing as follows (Note: The
following are general definitions. Please review regulations
for further information on filing claims for your commodity):

DRAWBACK - EXPORT - A qualified permittee, manufacturer,
or proprietor may file a claim for drawback of the tax on taxpaid spirits, wine or beer exported from the United States.
This type of claim can not be used for tobacco products
exported with the benefit of drawback.

REMISSION OF TAX - A qualified permittee, manufacturer,
or proprietor may file a claim for remission of tax on the
quantity of distilled spirits, (including distilling material and
denatured spirits) or tobacco products that were lost or
destroyed while in bond, if the tax has not been paid or
determined. A claim of this type may also be filed to cover
untaxpaid beer lost in transit between breweries and untaxpaid wine removed for export, but lost while in transit to the
point of export.

ABATEMENT OF TAX - A claim for abatement of tax on
firearms, ammunition, distilled spirits, wines, beer, or tobacco
products may be filed if the tax is assessed or has been
assessed excessively and the taxpayer believes that the
tax, or any portion of the tax, is not due.
REFUND OF TAX - A claim may be filed by a taxpayer for
a refund of taxes illegally, erroneously, or excessively collected. The claim must be filed within three years (two
years under certain circumstances) after the date the tax is
due, or paid, whichever is later.

Note:This type of claim may be filed only by the person who
is liable for paying the tax.
ALLOWANCE OF LOSS - A qualified permittee, manufacturer, or proprietor may file a claim for allowance of loss or relief
of tax liability on denatured spirits, wine, or beer that have
been lost or destroyed on the bonded premises, or wine lost
or destroyed in transit thereto, if the tax has not been paid or
determined.

ITEM 3.

Enter the claimant's name and address. (Telephone number
and e-mail address are optional)

ITEM 4.

Enter the claimant's employer identification number.

ITEM 5.

Enter the claimant's plant, license or registry number.

ITEM 6.

Enter the kind of tax (excise tax, special tax).

ITEM 7.

Enter the period for which the tax was due (this only applies
to special tax or nonbeverage claims). Enter in mm/dd/yy
format.

ITEM 8.

Enter the total amount of tax being claimed.

ITEM 9.

Enter the date the tax was paid (if paid) by the claimant.

ITEM 10.

Provide detailed information that may be required by the
applicable regulations pertaining to the claim along with any
other necessary facts. Also identify any documents or
statements submitted to support the claim.

ALLOWANCE OF CREDIT - A qualified permittee, manufacturer, or proprietor may file a claim for allowance of credit of
tax. The approved amount may be applied as credit toward
unpaid taxes or future tax liabilities.

ITEM 11.

Enter the signature and title of a person authorized to sign
on behalf of the company/claimant. The name of the person
signing the claim should be typed or legibly printed under or
beside the signature.

ALLOWANCE OF TAX - A tobacco manufacturer, proprietor
or permittee may file a claim for relief from the payment of
tax on tobacco products, if after determination of tax and

ITEM 12.

Enter the date the claim was signed.

Note:Taxpaid distilled spirits, wine, beer or tobacco
products which are lost or rendered unmerchantable by
accident, disaster, fire, casualty or act of God should
be filed as a claim for allowance of credit or claim for
refund.
DRAWBACK - MNBP - A manufacturer of nonbeverage
products may file a claim for drawback on distilled spirits
used in an TTB approved formula for use as a medicine,
medicinal preparation, food product, flavor, flavor extract or
any other TTB approved nonbeverage product. Formulas
which are stated in the current revisions or editions of the
United States Pharmacopoeia (U.S.P.), the National Formulary (N.F.), or the Homeopathic Pharmacopoeia of the
United States (H.P.U.S.) are considered approved formulas.

TTB F 5620.8 (5/2005)

ITEMS 13 - 22. For TTB use only.