OMB No. 1513-0020

OMB No. 1513-0020 (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

06285001000010

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

906

PART I - APPLICATION

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

BR-MI-DET-15000

3. SOURCE OF PRODUCT (Required)

	Domestic
	Imported

8. 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)

Atwater Block Brewery, DETROIT RIVERTOWN BREWING COMPANY, LLC
237 JOSEPH CAMPAU

DETROIT MI 48207

ATWATER BLOCK BREWERY (Used on label)

4. SERIAL NUMBER (Required)

061029

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

ATWATER

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

VANILLA JAVA PORTER

9. EMAIL ADDRESS

10. FORMULA/SOP NO.
(If any)

11. LAB. NO. & DATE / PREIMPORT NO. & DATE (If any)

18. 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. ___06184001000057___

12. NET CONTENTS

12 FL. OZ.

13. ALCOHOL CONTENT

6.0%

14. WINE APPELLATION IF ON LABEL

15. WINE VINTAGE DATE IF ON LABEL

16. PHONE NUMBER

(313) 877-9205

17. FAX NUMBER

19. 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.
STATEMENT OF PROCEES WAS APPROVED - 06254-003-000072. 841000:MTW ON SEPTEMBER 14, 2006 SIGNED BY MICHAEL T. WARREN. ADDED THE STATEMENT OF COMPOSITION TO THE LABEL AS REQUESTED ALSO. VANILLA EXTRACT APPROVED BY TTB. TTB1, KRAUSE AND COMPANY, WALLED LAKE, MI IS THE MANUFACTURER OF THE FLAVORING.

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.
20. DATE OF APPLICATION 10/12/2006	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT MARK RIETH

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.
23. DATE ISSUED 10/19/2006	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY
QUALIFICATIONS When new labels are printed, all the mandatory information excluding the alcohol content must appear in printing not smaller than two (2) millimeters. This includes lower case lettering. See 27 CFR 7.28 (b) (1). (List information to be corrected) (Statement of composition) STATUS THE STATUS IS APPROVED. 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: 4 inches W X 3.5 inches H

Label Image: Brand (front) or keg collar

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