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
06104001000070

1. REP. ID. NO. (If any)
CT
301

OR
18

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-ID-5
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)

BARDENAY, SETTLES KRICK, INC
155 E RIVERSIDE ST

EAGLE ID 83616

BARDENAY (Used on label)
3. SERIAL NUMBER (Required)
060001

4. TYPE OF PRODUCT (Required)
WINE
DISTILLED SPIRITS
MALT BEVERAGE

5. BRAND NAME (Required)
BARDENAY
7a. MAILING ADDRESS, IF DIFFERENT
6. FANCIFUL NAME (If any)
8. EMAIL ADDRESS
 
9. FORMULA/SOP NO.
(If any)
8
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
750 MILLILITERS
12. ALCOHOL CONTENT
40% ALC/VO
13. WINE APPELLATION IF ON LABEL
14. WINE VINTAGE DATE IF ON LABEL
15. PHONE NUMBER
(208) 869-0864
16. FAX NUMBER
(208) 426-8168
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.
N/A
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
04/14/2006
20. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
21. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
KEVIN SETTLES
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
04/16/2006
23. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Authorized Signature

FOR TTB USE ONLY
QUALIFICATIONS

STATUS
THE STATUS IS APPROVED.

CLASS/TYPE DESCRIPTION
VODKA 80-90 PROOF

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 2.06 inches W X 6.19 inches H


Label Image: Brand (front) or keg collar


Image Type:

Back
Actual Dimensions: 2.00 inches W X 3.25 inches H


Label Image: Back




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