OMB No. 1512-0092

OMB No. 1512-0092 (01/31/2009)

FOR TTB USE ONLY

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

APPLICATION FOR AND CERTIFICATION/EXEMPTION OF LABEL/BOTTLE APPROVAL

(See Instructions and Paperwork Reduction Act Notice on Back)

TTB ID

05273001000101

1. REP. ID. NO. (If any)

906

PART I - APPLICATION

2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)

BR-MO-ANH-1

7. NAME AND ADDRESS OF APPLICANT AS SHOWN ON PLANT REGISTRY, BASIC PERMIT OR BREWER'S NOTICE. INCLUDE APPROVED DBA OR TRADENAME IF USED ON LABEL (Required)

ANHEUSER-BUSCH, INC., ANHEUSER-BUSCH INC.
1 BUSCH PL

SAINT LOUIS MO 63118

3. SERIAL NUMBER (Required)

05YK09

4. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

5. BRAND NAME (Required)

SPYKES HOT CHOCOLATE

7a. MAILING ADDRESS, IF DIFFERENT

6. FANCIFUL NAME (If any)

HOT CHOCOLATE

8. EMAIL ADDRESS

9. FORMULA/SOP NO.
(If any)

05spSHC-01

10. LAB. NO./DATE
(If any)

17. TYPE OF APPLICATION (Check applicable box(es))

a.	CERTIFICATE OF LABEL APPROVAL
b.	CERTIFICATE OF EXEMPTION FROM LABEL APPROVAL "For sale in _______ only" (Fill in State abbreviation.)
c.	DISTINCTIVE LIQUOR BOTTLE APPROVAL. TOTAL BOTTLE CAPACITY BEFORE CLOSURE ____ _____ (Fill in amount)
d.	RESUBMISSION AFTER REJECTION TTB ID. NO. ______

11. NET CONTENTS

1.7 oz

12. ALCOHOL CONTENT

12 abv

13. WINE APPELLATION IF ON LABEL

14. WINE VINTAGE DATE IF ON LABEL

15. PHONE NUMBER

(314) 577-0635

16. FAX NUMBER

(314) 577-9862

18. SHOW ANY WORDING (a) APPEARING ON MATERIALS FIRMLY AFFIXED TO THE CONTAINER (e.g., caps, celoseals, corks, etc.) OTHER THAN THE LABLES AFFIXED BELOW, OR (b) BLOWN, BRANDED OR EMBOSSED ON THE CONTAINER (e.g., net contents etc.). THIS WORDING MUST BE NOTED HERE EVEN IF IT DUPLICATES PORTIONS OF THE LABELS AFFIXED BELOW. ALSO, PROVIDE TRANSLATIONS OF FOREIGN LANGUAGE TEXT APPEARING ON LABELS.
FRESHNESS DATE CODE AND WEBSITE. KOSHER SYMBOL, IF APPLICABLE TO BRAND. ANY WORDING REQUIRED BY STATES (ALC. CONTENT, DEPOSIT LANGUAGE) "RETURNABLE" OR "NON-RETURNABLE BOTTLE" MAY APPEAR ON BOTTLE LABELS.

PART II - APPLICANT'S CERTIFICATION
Under the penalties of perjury, I declare; that all statements appearing on this application are true and correct to the best of my knowledge and belief; and, that the representations on the labels attached to this form, including supplemental documents, truly and correctly represent the content of the containers to which these labels will be applied. I also certify that I have read, understood and complied with the conditions and instructions which are attached to an original TTB F 5100.31, Certificate/Exemption of Label/Bottle Approval.
19. DATE OF APPLICATION 09/30/2005	20. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	21. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT MARTHA MITCHELL

PART III - TTB CERTIFICATE
This certificate is issued subject to applicable laws, regulations and conditions as set forth in the instructions portion of this form.
22. DATE ISSUED 10/03/2005	23. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

Other (All of the mandatory information must appear in readily legible printing on a completely contrasting background.)
By 01/03/2006, the label and corresponding formula must comply with TTB TD-21. This final rule places limits on the quantity of alcohol in a malt beverage that may be derived from flavors and other nonbeverage ingredients, and requires an alcohol content statement on the brand label if product contains any alcohol derived from added flavors or other nonbeverage ingredients (other than hops extract) containing alcohol.

STATUS

THE STATUS IS SURRENDERED.

CLASS/TYPE DESCRIPTION

MALT BEVERAGES SPECIALITIES - FLAVORED

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: .94 inches W X 1.65 inches H

Label Image: Brand (front) or keg collar

Image Type:

Back
Actual Dimensions: .94 inches W X 1.65 inches H

Label Image: Back

TTB F 5100.31 (6/2006) PREVIOUS EDITIONS ARE OBSOLETE