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
07347001000013

1. REP. ID. NO. (If any)
CT
693

OR
63

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
KY-I-15007
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)

Smart Beverage Group, SMART & ASSOCIATES, LLC
14804 LANDIS LAKES DR

LOUISVILLE KY 40245

4. SERIAL NUMBER (Required)
070005

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

6. BRAND NAME (Required)
TWIN SHOT JAVA CREAM
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
COFFEE & VANILLA CREAM
9. EMAIL ADDRESS
 
10. FORMULA/SOP NO.
(If any)
11. LAB. NO. & DATE / PREIMPORT NO. & DATE (If any)
07284003000163 - 11/19/2007
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. ______
12. NET CONTENTS
100 MILLILITERS
200 MILLILITERS
13. ALCOHOL CONTENT
20
14. WINE APPELLATION IF ON LABEL
15. WINE VINTAGE DATE IF ON LABEL
16. PHONE NUMBER
(203) 438-2554
17. FAX NUMBER
(800) 820-6013
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.
IN ADDITION TO THE WRAP LABEL FOR THE AGGREGATE PACK, ALL MANDATORY INFORMATION IS APPEARS ON THE LID OF EACH CONTAINER. COPIES OF THE WRAP & LID ARTWORK ARE UPLOADED IN OTHER ATTACHMENTS. NOTE: THERE ARE TWO PRE-IMPORT LETTERS ASSOCIATED WITH THIS PRODUCT.
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
12/13/2007
21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
ANDREW WILE
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
01/07/2008
24. 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 SPECIALTIES

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3.77 inches W X 3.69 inches H


Label Image: Brand (front) or keg collar


Image Type:

Back
Actual Dimensions: 1.83 inches W X 2.53 inches H


Label Image: Back


Image Type:

Other
Actual Dimensions: 1.83 inches W X 2.53 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 3.26 inches W X 3.69 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 1.83 inches W X 1.37 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 3.77 inches W X 3.69 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 1.24 inches W X 1.09 inches H


Label Image: Other




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