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

OMB No. 1513-0049 (11/30/2009)

DEPARTMENT OF THE TREASURY

Text

MONTHLY REPORT OF PROCESSING (DENATURING) OPERATIONS

Text

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

NAME OF PROPRIETOR

LOCATION OF PLANT
SECTION I - DENATURED SPIRITS

SECTION II - RECOVERED DENATURED SPIRITS AND RECOVERED ARTICLES RECEIVED FOR
RESTORATION AND/OR REDENATURATION UNDER 27 CFR 19.683 1 AND RECOVERED
DENATURED SPIRITS AND RECOVERED ARTICLES ON MY BONDED PREMISES RECEIVED
FOR RESTORATION AND/OR REDENATURATION.

WINE GALLONS
TRANSACTION

COMPLETELY
DENATURED
ALCOHOL
(b)

(a)

SPECIALLY
DENATURED
ALCOHOL
(c)

PLANT NUMBER
DSP-

SPECIALLY
DENATURED
RUM
(d)

WINE GALLONS
TRANSACTION

1. On hand first of month
2. Produced
3. Rec’d by transfer in bond 3
4.
5. TOTAL, Lines 1-4
6. Transfers to dealers & users (exc. Line 7 & 10)
7. Federal Government SDS (except Line 10)
8. Transferred in bond
9. For use in mfg. of articles on
my bonded premises
10. Withdrawn for fuel use (AFP Premises)
11. Losses
12.
13. On hand end of month
14. TOTAL, Lines 6-13

(a)

COMPLETELY
DENATURED
ALCOHOL

18
19
20
TOTAL
Specially Denatured Alcohol
1
2-B
2-C
3-A
3-B
4
6-B
12-A
13-A
17
18
19
TTB F 5110.43 (10/2008)

FORMULA
NUMBER

20
22
23-A
23-F
23-H
25
25-A
27
27-A
27-B
28-A
29
30
31-A
32
33
35

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
24. TOTAL, Lines 20-23
SECTION III - WINE GALLONS OF DENATURED SPIRITS WITHDRAWN (Reporting period July 1 - June 30, 20____.)
If this is a final report ending on a date other than June 30, provide the ending period date: _________________

FORMULA
NUMBER

RECOVERED
DENATURED
SPIRITS
(b)

SPECIALLY
DENATURED
ALCOHOL

FORMULA
NUMBER

35-A
36
37
38-B
38-C
38-D
38-F
39
39-A
39-B
39-C
39-D
40
40-A
40-B
40-C
42

SPECIALLY
DENATURED
ALCOHOL

FORMULA
NUMBER

SPECIALLY
DENATURED
ALCOHOL

44
45
46

Under penalties of perjury, I declare that I have examined this report and,
to the best of my knowledge and belief, it is a true and complete report of
denaturing operations.
DATE

PROPRIETOR

BY (Signature and title)

INSTRUCTIONS
1. Each proprietor of a distilled spirits plant who is authorized to process, including
the denaturing of spirits, must prepare the form in duplicate monthly, forward the
original to the Director, National Revenue Center, 550 Main St., Ste. 8002,
Cincinnati, OH 45202-5215, no later than the 15th day of the month following the
month for which prepared, and retain a copy for his or her files.

Special Formulas

TOTAL
Specially Denatured Rum
4

2. Section III is to be completed for the period July 1 - June 30. If this is a final
report filed on permanent discontinuance of business, the end of period may be
other than June 30th..
FOOTNOTES
1/ Do not include recovered denatured spirits and article s returned for redistillation
under 27 CFR 19.683. Such products should be reported on TTB F 5110.40,
Monthly Report of Production Operations.
2/

premises. Do not include denatured spirits transferred in bond to other bonded

3/

Imported denatured spirits received from Customs custody for fuel use should be
reported separately on line 4.

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 statute (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 (10/2008)