Form TTB F 5200.11 TTB F 5200.11 Notice of Release of Tobacco Products, Cigarette Papers,

OMB No. 1513-0025

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

NOTICE OF RELEASE OF TOBACCO PRODUCTS, CIGARETTE PAPERS, OR CIGARETTE TUBES
PART I - Identification of Recipient (Export Warehouse Proprietor or Manufacturer) and Importer
1. NAME OF RECIPIENT EXPORT WAREHOUSE PROPRIETOR OR MANUFACTURER 2. LOCATION OF RECIPIENT'S PREMISES (Number, Street, City, State, ZIP Code)

A.
TO:

3. PERMIT OR FACTORY NO. OF RECIPIENT

NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
550 MAIN ST, STE 8002
CINCINNATI, OHIO 45202-5215

4. EIN OF RECIPIENT

5. PERMIT NO. OF IMPORTER

(see instruction 6)

6. ARTICLES TO BE RECEIVED
CIGARS OR CIGARETTES
CIGARETTE PAPERS OR TUBES

SMOKELESS TOBACCO
PIPE TOBACCO

ROLL-YOUR-OWN TOBACCO

7. TYPE OF RELEASE (check one only)

IMPORTED ARTICLES (see instruction 5)

FOR TTB USE ONLY

AF
T

OPTIONAL INFORMATION ABOUT EXPORT WAREHOUSE OR MANUFACTURER
TELEPHONE NUMBER
E-MAIL ADDRESS

DOMESTIC ARTICLES (see instruction 5)

AUDITED BY

DATE

PART II - CERTIFICATION BY AUTHORIZED TTB OFFICIAL
This is to certify that the manufacturer/proprietor identified in Part I is a qualified manufacturer/proprietor as indicated and is authorized to receive the kind of
articles specified in Part I, Item 6, without payment of the Internal Revenue tax under 26 U.S.C. 5704(c), or without payment of that part of duty attributable to
the excise tax under 26 U.S.C. 5704(d).
8.

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

9.

DATE

TRANSACTIONS AUTHORIZED. Tobacco products,
and cigarette papers or tubes imported or brought into
the United States may, under 26 U.S.C. 5704(c) or (d), be
released from Customs custody to an export warehouse
proprietor or a manufacturer of tobacco products. Also,
cigarette papers or tubes may be released under 26 U.S.C.
5704(c) or (d) to a manufacturer of cigarette papers and
tubes. (For regulatory provisions see 27 CFR Part 41.)

B.

R

TO:
(Insert Name
and mailing
address of
RECIPIENT
manufacturer
or proprietor)

PART III - NOTIFICATION OF RELEASE BY CUSTOMS BONDED WAREHOUSE PROPRIETOR OR GOVERNMENTAL OFFICER WITH CUSTODY OF THE PRODUCT

On the date shown in item 11, the following quantities of tobacco products, cigarette papers, and cigarette tubes were either released from Customs custody
or returned by a governmental agency to the recipient proprietor or manufacturer indicated in Part I above.
10. ARTICLES RELEASED
LARGE
CIGARS
(Number)

LARGE
CIGARETTES
(Number)

SMALL
CIGARETTES
(Number)

CIGARETTE
PAPERS
(Number)

(a)

(b)

(c)

(d)

(e)

CIGARETTE
TUBES
(Number)

CHEWING
TOBACCO
LBS.
OZ.

SNUFF

PIPE
TOBACCO
LBS. OZ.

ROLL-YOUR-OWN
TOBACCO
LBS. OZ.

(f)

(g)

(i)

(j)

D

SMALL
CIGARS
(Number)

11. SIGNATURE OF CUSTOMS WAREHOUSE PROPRIETOR
OR RELEASING GOVERNMENTAL OFFICIAL
TTB F 5200.11 (07-2017)

LBS.

OZ.
(h)

12. TITLE

13. DATE

INSTRUCTIONS
ACTION BY PROPRIETOR OR MANUFACTURER SEEKING RELEASE
1. Prepare in triplicate.

6. For tobacco products, enter the TTB permit number of the importer.
Leave this field blank if you are seeking release of only cigarette papers
and tubes.

2. Complete Part I and item B of Part II.
3. Mail all three copies to the National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau. The authorized TTB official will return
all three copies after completing the certification in Part II.
4. Present all copies to the Customs bonded warehouse proprietor or the
government officer having official custody of the products.

1. Complete Part III. In item 10, show the actual quantity of products
released, and execute items 11, 12, and 13.
2. Mail the original of the form to the National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau, shown in item A.
3. Keep one copy and return a copy to the proprietor or manufacturer
receiving the product.

AF
T

5. Identify as “domestic” those articles that were manufactured in the
United States. Do not identify articles manufactured outside the 50
states and the District of Columbia as domestic articles. 26 U.S.C.
5754 restricts what can be done with domestic articles manufactured in
the United States and labeled for exportation under 26 U.S.C. Chapter
52. Identify articles that are manufactured outside the United States as
imported articles. For example, identify articles of Puerto Rican
manufacture as “imported.”

ACTION BY RELEASING GOVERNMENT OFFICIAL OR CUSTOMS
WAREHOUSE PROPRIETOR

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. The information collection documents transactions of taxable commodities on
which tax has not been paid. TTB uses the information to determine that the transaction is in accordance with the laws and regulations and establishes
the person responsible for the tax involved in the transaction. The information requested is mandatory by statute (27 U.S.C. 5704 and 5741).

R

The estimated average burden associated with this collection of information is 15 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 the
Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, 1310 G Street, NW, Box 12, Washington,
DC 20005

D

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 5200.11 (07-2017)