TTB F 5100.11 Withdrawal of Spirits, Specially Denatured Spirits, or W

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DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

WITHDRAWAL OF SPIRITS, SPECIALLY DENATURED SPIRITS, OR WINES FOR EXPORTATION

OMB No. 1513-0037
1. SERIAL NO. (Begin with
“1” each Jan. 1)

Please read Instructions after Page 3 before completing this form.

2. APPLICATION IS MADE TO
WITHDRAW SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
4. WITHDRAWAL FROM

PART I - APPLICATION OR NOTICE
3. NOTICE GIVEN OF
WITHDRAWAL OF SPECIALLY
DENATURED SPIRITS FREE OF TAX
OPERATED BY

BW. ______________________
DSP. _______________________
6. PURPOSE
OF WITHDRAWAL
(Make
Applicable
Entries)

SHIPMENT FOR
EXPORT TO ARMED
FORCES OF THE U.S.

WITHDRAWAL OF SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
5. ADDRESS OF DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
550 MAIN ST, STE 8002
CINCINNATI, OH 45202-5215

FOR EXPORTATION TO(Name the foreign port and country) TRANSFER TO (Number or name and location)
CMBW

USE AS SUPPLIES ON VESSELS

1/

FTZ

CBW

1/

AIRCRAFT

7. CONSIGNED TO OR IN CARE OF (Make applicable entries)
DIRECTOR OF CUSTOMS AT PORT OF (Specify)
TRANSPORTATION OFFICER (Name) (Location)
CUSTOMS OFFICER/WAREHOUSE PROPRIETOR OF

CMBW

FTZ

CBW

(Location)
8. NAME OF DOMESTIC CARRIER

9. NAME OF EXPORT CARRIER

10. DESCRIPTION OF SPIRITS OR DENATURED SPIRITS AND CONTAINERS (Columns a, d, e, and f only are required for denatured spirits)
PRODUCED BY
KIND 2/
(a)

NAME
(b)

FILLED BY
DSP NO.
(c)

PG 3/

CONTAINERS
NO. AND TYPE

(d)

IDENTIFICATION
(e)

WG
(f)

Select this checkbox if you need to add additional description of spirits or denatured spirits and containers.
11. DESCRIPTION OF WINES AND CONTAINERS
KIND
(a)

PERCENT
ALCOHOL
(b)

NO. AND TYPE
(c)

CONTAINERS
SERIAL NUMBER 4/
(d)

BOTTLES
PER CASE
(e)

SIZE OF
BOTTLES
(f)

WINE
GALLONS
(g)

TAX
LIABILITY
(h)

Select this checkbox if you need to add additional description of wine and containers.
Under the penalties of perjury, I declare that the spirits, denatured spirits, or wines described above are truly intended to (or have been) withdrawn for the purpose
indicated, in the manner prescribed in regulations, and will not be (have not been) shipped for the purpose of evading or delaying payment of any revenue tax thereon.

12. DATE

14. DATE

13. PRINCIPAL5/

13a. SIGNATURE

13b. TITLE

FOR TTB USE ONLY PART II - APPROVAL OF APPLICATION
15. SIGNATURE AND TITLE OF APPROVING OFFICER

1/ State whether (a) vessel or aircraft operated by the United Slates; (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 Slates; (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 aircraft.
2/ Also enter formula number for special denatured spirits.
3/ Enter quantity of spirits in proof gallons or quantity of denatured spirits in wine gallons and check applicable box.
4/ In Items 11(d) and 22 show filling date when use of that date is authorized instead of serial numbers on cases. Item 11(d) need not be completed when prior approval of application is required.
5/ Show principal on bond under which withdrawal is made. Do not complete this section if the exporter is exempt from bond requirements under 27 CFR 28.51(b). An exporter is exempt only if all of the following are true: the distilled spirits or wine to be
exported is for nonindustrial use; the exporter is a taxpayer (as defined in § 28.51(c)) who reasonably expects to be liable for not more than $50,000 in taxes described in 26 U.S.C. 5061(d)(4) during the current calendar year; the exporter was liable for not
more than $50,000 in such taxes in the preceding calendar year; and the exporter pays such taxes on a deferred basis using a semimonthly, quarterly, or annual return period as described in 26 U.S.C. 5061(d).

TTB F 5100.11 (11/2016)

Page 1 of 3

PART III - PROPRIETOR’S REPORT OF INSPECTION AND TAX LIABILITY
The spirits described on Page 1 were inspected, as reported below, and have been prepared for withdrawal as required by regulations.
16. WITHDRAWAL IS FROM:
17.
PACKAGE GAUGE
RECORD ATTACHED
PRODUCTION ACCOUNT
STORAGE ACCOUNT
PROCESSING ACCOUNT
18.

CONTAINERS (Leave blank if no change)

QUANTITY
DETERMINED BY

NUMBER
(a)

TAXABLE
GALLONS
(c)

IDENTIFICATION
(b)

TAX
LIABILITY
(d)

GAUGE FOR
INSPECTION
WITHDRAWAL
REGAUGE AFTER REDUCTION IN
PROOF
19. DATE

20. PROPRIETOR OF DISTILLED SPIRITS PLANT

20a. BY (Signature and title)

PART IV - CERTIFICATE OF REMOVAL OF WINE FROM BONDED WINE CELLAR (Complete only if approval of application is required)
21. REMOVED FROM BONDED WINE CELLAR 22. SERIAL NUMBERS OF CONTAINERS 4/
NO.

I certify that the wines described above
were removed for the purpose stated in
Item 6.

23. DATE REMOVED 24. PROPRIETOR OF BONDED WINE CELLAR

24a. BY (Signature and title)

PART V - CUSTOMS OFFICER’S REPORT OF INSPECTION AND LADING, SHIPMENT, OR RECEIPT
25. NOT INSPECTED (Give reason for not inspecting)
25a. INSPECTED AND FOUND TO BE AS DESCRIBED
EXCEPT AS NOTED IN ITEM 31
26. RECORDS OF DELIVERING AND EXPORTING CARRIERS SHOW THAT CONTAINERS OF SIMILAR DESCRIPTION
WERE RECEIVED BY THE EXPORTING CARRIER FOR DELIVERY TO THE FOREIGN PORT NAMED IN ITEM 6
AND WERE LADEN ON BOARD THE EXPORTING CONVEYANCE AS REPORTED IN THIS FORM.
ON BOARD: VESSEL (Name)

28. LADEN FOR
EXPORT

AIRCRAFT (Name, symbols, number)

USE AS
RAILROAD CAR (Number)
SUPPLIES

29. RECEIVED IN
CMBW
FTZ

(No. or Location)

27. LADEN ON (Date)

TRUCK (State license)
30. SHIPPED TO (Frontier port)

SERIAL NUMBER ON SEAL USED

CBW

31. DISCREPANCY OR SHORTAGE

32. DATE

33. PORT

35. FRONTIER PORT

34. SIGNATURE AND TITLE OF CUSTOMS OFFICER/WAREHOUSE PROPRIETOR

PART VI - CUSTOMS OFFICER’S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
36. DATE RECEIVED 37. INSPECTION DISCLOSED
NO EVIDENCE OF TAMPERING

SEALS INTACT

SEALS BROKEN (See item 38)

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

39. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 28, BEARING THE SHIPMENT DESCRIBED
IN PART I, WITH EXCEPTIONS AS NOTED IN ITEMS 31 AND 38 CLEARED FROM THIS PORT FOR
THE PORT OF
40. DATE

Foreign Port

41. SIGNATURE AND TITLE OF CUSTOMS OFFICER

PART VII - CERTIFICATE OF CLEARANCE OR USE
42. THE EXPORTING CONVEYANCE BEARING THE SHIPMENT DESCRIBED IN PART I, WITH EXCEPTIONS AS NOTED ABOVE -CLEARED FROM PORT OF
ON (Date)
BOUND FOR (Foreign port)
43. THE SPIRITS OR WINES DESCRIBED HAVE BEEN USED AS SUPPLIES ON THE AIRCRAFT OR FISHING VESSEL IDENTIFIED ABOVE AND
THE REQUIRED EVIDENCE OF THEIR USE HAS BEEN RECEIVED.
44. DATE

45. SIGNATURE OF DISTRICT DIRECTOR OF CUSTOMS

PART VIII - CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
The distilled spirits or wines, described in Part I, with exceptions as noted in Item 47, were received for export to the Armed Forces of the United States.
The spirits or wines will not be shipped f or consumption or use to any place subject to application of the Internal Revenue laws of the United States.
46. DATE

47. DISCREPANCY

48. SIGNATURE

TTB F 5100.11 (11/2016)

49. RANK
Page 2 of 3

50. TITLE

(Continuation)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

.
WITHDRAWAL OF SPIRITS, SPECIALLY DENATURED SPIRITS, OR WINES
FOR EXPORTATION

OMB No. 1513-0037
1. SERIAL NO. (Begin with
“1” each Jan. 1)

Please read Instructions after Page 3 before completing this form.

2. APPLICATION IS MADE TO
WITHDRAW SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
4. WITHDRAWAL FROM

PART I - APPLICATION OR NOTICE
3. NOTICE GIVEN OF
WITHDRAWAL OF SPECIALLY
DENATURED SPIRITS FREE OF TAX
OPERATED BY

BW. ______________________
DSP. _______________________

WITHDRAWAL OF SPIRITS OR WINES
WITHOUT PAYMENT OF TAX
5. ADDRESS OF DIRECTOR, NATIONAL REVENUE CENTER
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
550 MAIN ST, STE 8002
CINCINNATI, OH 45202-5215

10. DESCRIPTION OF SPIRITS OR DENATURED SPIRITS AND CONTAINERS (Columns a, d, e, and f only are required for denatured spirits)
PRODUCED BY
KIND 2/
(a)

NAME
(b)

FILLED BY
DSP NO.
(c)

PG 3/

CONTAINERS
NO. AND TYPE

(d)

IDENTIFICATION
(e)

WG
(f)

11. DESCRIPTION OF WINES AND CONTAINERS
KIND
(a)

PERCENT
ALCOHOL
(b)

NO. AND TYPE
(c)

CONTAINERS
SERIAL NUMBER 4/
(d)

BOTTLES
PER CASE
(e)

SIZE OF
BOTTLES
(f)

WINE
GALLONS
(g)

TAX
LIABILITY
(h)

Under the penalties of perjury, I declare that the spirits, denatured spirits, or wines described above are truly intended to (or have been) withdrawn for the purpose
indicated, in the manner prescribed in regulations, and will not be (have not been) shipped for the purpose of evading or delaying payment of any revenue tax
thereon.
12. DATE
TTB F 5100.11 (11/2016)

13. PRINCIPAL5/

13a. SIGNATURE

Page 3 of 3

13b. TITLE

INSTRUCTIONS
(Read Prior to Completing Form)
1. EXPORTER.
a. GENERAL. Prepare Part I of this form in quadruplicate. Prepare a
fifth copy, marked “consignee’s copy” when distilled spirits or wines
are for use on aircraft.
b. APPLICATION. As provided in 27 CFR Part 28, this form must be
prepared as an application if the exporter is not the proprietor of
the bonded premises from which the spirits or wines are to be
withdrawn. Before withdrawal is made, application for withdrawal of
spirits or wines must be approved by the Director, National Revenue
Center, Alcohol and Tobacco Tax and Trade Bureau.
c. NOTICE. If the exporter is the proprietor of the bonded premises
from which the spirits (including denatured spirits) or wines are to
be withdrawn, the form must be prepared as a notice.
2. SHIPMENTS - DISPOSITION OF FORMS.
a. DISTILLED SPIRITS OR DENATURED SPIRITS. The proprietor
of the distilled spirits plants must enter the results of any required
inspection and regauge in Part III and distribute the form, as
follows:
(1) forward the original and one copy (with any attachments) to the
official designated in Item 7,
(2) forward a copy (with any attachments) to the Director, National
Revenue Center, TTB, and
(3) retain a copy for his/her files.
In the case of shipment by tank truck, the forms must be placed in
a properly addressed sealed envelope and handed to the driver of
the truck for delivery to the officer to whom the shipment is
consigned.
b. WINES. The proprietor must complete Part IV, if applicable, and
distribute the form, as follows:
(1) forward the original and one copy to the official designated in
Item 7,
(2) forward a copy to the Director, National Revenue Center, TTB,
and
(3) retain the copy for his/her files.
c. CONSIGNEE’S COPY. If a consignee’s copy has been prepared
as required by Instruction 1a above, the proprietor must forward it
to the airline company official at the airport.
3. ACTION BY WAREHOUSE PROPRIETOR OR CUSTOMS OFFICIAL.
a. SHIPMENTS FOR DIRECT EXPORTATION OR FOR USE ON
VESSELS OTHER THAN FISHING VESSELS. After inspection of
lading, the Customs officer must complete Part V on both copies
and forward them (with any attachments) to the District Director of
Customs. On clearance of the conveyance, the District Director
must complete Part VII, forward the original (with any attachments)
to the Director, National Revenue Center, TTB at the address shown
in Item 5, and retain the copy for his/her files.

b. USE ON AIRCRAFT OR FISHING VESSELS. After inspection of
lading, the Customs officer must complete Part V on both copies
and forward them (with any attachments) to the District Director of
Customs. On receipt of the required certificate of use (for aircraft)
or Customs Form 5125 (for fishing vessels), the District Director of
Customs must complete Part VII, forward the original (with any
attachments) to the Director, National Revenue Center, TTB, at the
address shown in Item 5, and retain the copy for his/her files.
c. LADING AT INTERIOR PORT AND EXPORTATION THROUGH
FRONTIER PORT. On completion of lading, the Customs office
must affix the seals and complete Part V on both copies and
forward them (with any attachments) to the District 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 District Director of Customs so
provide, the copies may be forwarded via the truck driver to the
Customs officer at the frontier port. When satisfied that the
shipment has been exported, that officer must complete Part VI on
both copies and return them (with any attachments) to the District
Director of Customs at the interior port. The District Director must
then execute Part VII on both copies , forward the original (with any
attachments) to the Director, National Revenue Center, TTB, at the
address shown in Item 5, and retain the copy for his/her files.
d. RECEIPT IN MANUFACTURING BONDED WAREHOUSE. On
receipt of the shipment, the warehouse proprietor must make a
report of his/her gauge on Customs Form 6001, complete Part V and
attach a copy of the Form 6001 to each copy of the form, forward
the original (with any attachments) to the Director, National Revenue
Center, TTB, at the address shown in Item 5, and retain the copy for
his/her files.
e. RECEIPT IN FOREIGN -TRADE ZONE. On receipt of the
shipment, the Customs officer in charge must, if necessary, make a
report of gauge on Customs Form 6001, complete Part V and
attach a copy of the Form 6001 to each copy of the form, forward
the original (with any attachments) to the Director, National Revenue
Center, TTB, at the address shown in Item 5, and retain the copy for
his/her files.
f. RECEIPT IN CUSTOMS BONDED WAREHOUSE. On receipt of
the shipment, the warehouse proprietor must complete Part V, forward the original (with any attachments) to the Director, National
Revenue Center, TTB, at the address shown in Item 5, and retain
the copy for his/her files.
4. ACTION BY ARMED FORCES OFFICER.
On receipt of the
shipment, the officer to whom consigned (or other authorized supply
officer) must complete Part VIII on both copies of the form, forward the
original (with any attachments) to the Director, National Revenue
Center, TTB, at the address shown in Item 5, and retain the copy for
his/her files.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to ensure that spirits withdrawn from bond
without payment of tax are used only for the pur pose authorized by law. This collection is also necessary to ensure that the proprietor’s bond coverage for
the type of withdrawals is not exceeded. The information requested is mandatory by statute (26 U .S.C. 5066, 5214, and 5362).
The estimated average burden associated with this collection of information is 30 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.
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 5100.11 (11/2016)