Form TTB F 5629.8 TTB F 5629.8 Claim - Alcohol, Tobacco, and Firearms Taxes

OMB No. 1513-0030 (09/30/2008)

DEPARTMENT OF THE TREASURY

FOR TTB USE ONLY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

CLAIM - ALCOHOL, TOBACCO, AND FIREARMS TAXES

CLAIM NUMBER

(File in duplicate with the Alcohol and Tobacco Tax and Trade Bureau)
1. THIS CLAIM IS FILED UNDER THE PROVISIONS OF 27 CFR (Enter applicable section of regulations, such as 53, 40.283, or 40.173. See www.ttb.gov.)

2.

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)

3. 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 ONLY (mm/dd/yy)
FROM
8. AMOUNT OF TAX

TO

9. DATE(S) OF PAYMENT (for refunds ONLY)

10. DIRECT DEPOSIT
10b. TYPE

CHECKING

10a. ROUTING NUMBER
SAVINGS

10c. ACCOUNT NUMBER
11. 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)
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 the
Reports Management Officer, Regulations and Ruling 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.
Under the penalties of perjury, I declare that I have submitted this claim, including supporting documents and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
12. SIGNATURE (Type or print name and title under or beside signature)

TTB F 5620.8 (05/2008)

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13. DATE

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 http://www.ttb.gov.

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):
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
underpaid beer lost in transit between breweries and
underpaid wine removed for export, but lost while in
transit to the point of export.
Note:

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 of which the tax was due (this only
applies to special tax or nonbeverage claims). Enter the
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. Direct Deposit is a safe and secure way to have your refund
deposited automatically.

This type of claim may be filed only by the person
who is liable for paying the tax.

ITEM 10a. The routing number must be nine digits. On the sample check
below, the routing number is 250250025.

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 10b. Check the appropriate box for the type of account. Do not
check more than one box.
ITEM 10c. The account number can be up to 17 characters (both
numbers and letters). Include hyphens but omit spaces and
special symbols. On the sample check below, the account
number is 20202086.

Note: Tax paid 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.

1234

JEFFREY MAPLE
SUZANNE MAPLE
123 Pear Lane
Anyplace, VA 20000

DRAWBACK – MNBP – A manufacturer of nonbeverage
products may file a claim for drawback on distilled spirits
used in a 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.

15-0000/0000

PAY TO THE
ORDER OF

$

DOLLARS
ANYPLACE BANK
Anyplace, VA 2000

Routing
number
ITEM 10a

Account
number
ITEM 10c

Do not include the
check number

For
25025002

20202086

1234

ITEM 11. 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 permitted,
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 12. 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, export
warehouse proprietor, or permittee may file a claim for relief
from thepayment of tax on tobacco products, if after
determination of tax and 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 13. Enter the date the claim was signed.

DRAWBACK- EXPORT - A qualified winery, distilled spirits
plant, brewery, or tobacco manufacturer may file a claim for
drawback of the tax on taxpaid spirits, wine or beer exported
from the United States. This type of claim cannot be used for
tobacco products exported with the benefit of drawback.
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.

TTB 5620.8 (05/2008)

ITEM 3.

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