Form TTB F 5130.12 TTB F 5130.12 Beer for Exportation

Form Approved: OMB No. 1513-0114 (//)
DEPARTMENT OF THE TREASURY - ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

BEER FOR EXPORTATION

1. SERIAL NO. (Begin with
"1" for each January 1)

INSTRUCTIONS TO BREWER. Execute Part I in quadruplicate, except prepare a fifth copy, marked "Consignee's Copy," when the shipment is for use on an aircraft.
On removal of the beer, forward the original and one copy to the official designated in item 6, send one copy to the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau (address in item 2 below), and retain a copy in your files. If a "Consignee's Copy" has been prepared, forward it to the airline company
at the airport.
PAPERWORK REDUCTION ACT NOTICE - This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by brewers
to notify TTB of beer to be exported without payment of tax. This information is mandatory by 26 U.S.C. 5053.
The estimated average burden associated with this collection of information is 1 hour and 39 minutes 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 Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, 1310 G Street, NW, Washington, D.C. 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.

PART I - NOTICE
2.

The undersigned gives notice of removal, without payment of tax, of the
beer described below.

TO: DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
550 Main St, Ste 8002
Cincinnati, OH 45202-5215

3. BREWERY
4. ADDRESS (City and State)

5. REMOVED FOR
5a. EXPORT TO ARMED FORCES OF U.S.
Yes
No

5c. TRANSFER TO FOREIGNTRADE ZONE (Number and location)

5b. EXPORTATION TO (Name of foreign port and country)

5d. SUPPLIES ON VESSEL OR AIRCRAFT1

6. CONSIGNED TO OR IN CARE OF
6a. DIRECTOR OF CUSTOMS (Port)
6b. TRANSPORTATION OFFICER (Name and location)
6c. CUSTOMS OFFICER IN CHARGE OF FOREIGN-TRADE ZONE (Number and location)
7. NAME OF DOMESTIC CARRIER
9. DESCRIPTION OF BEER
CONTAINERS
KIND
(a)

NUMBER
(b)

QTY. EACH
(c)

8. NAME OF EXPORT CARRIER

TAX LIABILITY
$7 RATE2
(e)

TOTAL
QUANTITY
(d)

CONTAINERS
KIND
(a)

NUMBER
(b)

QTY. EACH
(c)

TAX
LIABILITY
(e)

TOTAL
QUANTITY
(d)

$

$

$

$

$

$

$

$

$

$

$

$

Under penalties of perjury, I declare that the beer described above was removed, for the purpose indicated and in the manner prescribed by regulations, on
the date shown in item 10.
10. DATE REMOVED

11a. BY (Signature and Title)

11. BREWER
FOOTNOTES

State whether (a) vessel or aircraft operated by the United States; (b) vessel
or aircraft engaged in foreign trade, or in trade between the United States and
any of its possessions, or between Hawaii or Alaska and any other part of the
United States; (c) vessel of the United States engaged in trade between
Atlantic and Pacific ports of the United States; (d) vessel of war of any foreign
nation; or (e) vessel employed in (1) the fisheries, or (2) the whaling business.
Show name of vessel, country of registry, and ports of call, or if a whaling
vessel, location of operations. If aircraft, show also name of airline and country
of registry of the aircraft.
1

TTB F 5130.12 (08/2009)

2
Brewers (qualified under 27 CFR 25.167) who taxpay 60,000 or less
barrels of beer in the calendar year in which the beer described in item 9 is
removed from the brewery for exportation, will indicate the reduced $7 rate of
tax by checking the box in item 9(e), and will compute the tax liability at the
reduced rate. All other brewers (including those qualified under 27 CFR
25.167) who taxpaid or will taxpay in excess of 60,000 barrels of beer in that
calendar year will compute the tax liability at the higher rate of $18.

Page 1 of 2

PART II - CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT
ACTION BY CUSTOMS. (a) Shipments For Direct Exportation. After
inspection of lading, the Customs Officer will execute Part II on both
copies and forward them to the Director of Customs. On clearance of
the conveyance, the Director of Customs will execute Part IV; forward
the original to the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau, at the address shown in item 2; and
retain the copy for his/her files.
(b) Supplies On Aircraft and Vessels Other Than Fishing Vessels. After
inspection of lading, the Customs Officer will execute Part II on both
copies; forward the original to the Director, National Revenue Center,
Alcohol and Tobacco Tax and Trade Bureau, at the address shown in
item 2; and retain the copy for his/her files.
(c) Supplies On Fishing Vessels. After inspection of lading, the
Customs Officer will execute Part II on both copies and forward them to
the Director of Customs; the Director of Customs, on receipt of required
Customs Form 5125 showing use as supplies will execute Part IV; forward
the original to the Director, National Revenue Center, Alcohol and Tobacco
Tax and Trade Bureau, at the address shown in item 2; and retain the

copy for his/her files.
(d) Lading at Interior Port for Exportation Through Frontier Port. On
completion of lading, the Customs Officer will affix the seals, then execute Part II on both copies and forward them to the Director of Customs
at the interior port for forwarding to the Customs Officer at the frontier
port; provided, that where the shipment is by truck and where instructions from the Director of Customs so provide, the copies may be
forwarded via the truck driver to the Customs Officer at the frontier port.
That Officer, when satisfied that the shipment has been exported, will
execute Part III on both copies and return them to the Director of
Customs at the interior port. The Director of Customs will then execute
Part IV; forward the original to the Director, National Revenue Center,
Alcohol and Tobacco Tax and Trade Bureau, at the address shown in
item 2; and retain the copy for his/her files.
(e) Receipt at Foreign-Trade Zone. On receipt of the beer, the
Customs Officer will execute Part II on both copies; forward the
original to the Director, National Revenue Center, Alcohol and Tobacco
Tax and Trade Bureau, at the address shown in item 2; and retain the
copy for his/her files.

12. I certify that the beer described in Item 9 was found to be as described, except as noted in Item 13, and that the beer was laden for:
export or
use as supplies on board:
12a. VESSEL (Name )

12e. SHIPPED TO (Frontier Port)

12b. AIRCRAFT (Name, Symbols, Number)

12f. SERIAL NUMBERS OF SEALS USED

12c. RAILROAD CAR (Number)
12d. TRUCK (State license )

12g. RECEIVED IN FOREIGNTRADE ZONE (Number)

13. INSPECTION DISCLOSED
NO EVIDENCE OF TAMPERING
DISCREPANCIES OR SHOT SHIPMENT, AS FOLLOWS:
14. PORT

15. DATE

NO DISCREPANCY
16. SIGNATURE AND TITLE OF CUSTOMS OFFICER

PART III - CUSTOMS OFFICER'S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
19. INSPECTION DISCLOSED

18. DATE RECEIVED

17. FRONTIER PORT

20. DETAILS OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.

NO EVIDENCE
OF TAMPERING

SEALS BROKEN
(See item 20)

SEALS
INTACT

21. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 12, BEARING THE BEER DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED IN
ITEM 13 AND 20, CLEARED FROM THIS PORT FOR THE PORT OF:(Foreign Port)
22. DATE

23. SIGNATURE AND TITLE

PART IV - CERTIFICATION OF CLEARANCE OR USE
24. THE EXPORTING CONVEYANCE BEARING THE BEER DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED ABOVE
CLEARED FROM THE PORT OF

ON (Date)

BOUND FOR

25.

THE BEER DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED IN ITEM 13, HAS BEEN USED AS SUPPLIES ON THE FISHING
VESSEL IDENTIFIED HEREIN, AND THE REQUIRED EVIDENCE OF SUCH USE HAS BEEN RECEIVED.
26. DATE
27. SIGNATURE OF DIRECTOR OF CUSTOMS
PART V - CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
RECEIPT BY ARMED FORCES OFFICER. On receipt of the beer, the officer to whom consigned (or other authorized supply officer) will execute Part V
on both copies; forward the original to the Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau, at the address shown in item 2;
and retain the copy for his/her files.
The beer described in Item 9, with exceptions as noted in Item 29, was received for export to the Armed Forces of the United States. The beer will not be
shipped for consumption for use in any place subject to application of the Internal Revenue laws of the United States.
28. DATE
30. SIGNATURE

29. DISCREPANCY
31. RANK

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32. TITLE
TTB F 5130.12 (08/2009)