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 07360001000044
1. REP. ID. NO. (If any) CT 699 OR 51

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required) IL-I-596 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) WEIN-BAUER, INC. 4031 TUGWELL ST FRANKLIN PARK IL 60131
4. SERIAL NUMBER (Required) 070300 5. TYPE OF PRODUCT (Required) WINE DISTILLED SPIRITS MALT BEVERAGE
6. BRAND NAME (Required) DISTILLERIE PAUL DEVOILLE	8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any) LIBERTINE

9. EMAIL ADDRESS	10. FORMULA/SOP NO. (If any)	11. LAB. NO. & DATE / PREIMPORT NO. & DATE (If any) B200700072001 - 08/20/2007	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. ___07303001000036___
12. NET CONTENTS 750 MILLILITERS	13. ALCOHOL CONTENT 58	14. WINE APPELLATION IF ON LABEL
15. WINE VINTAGE DATE IF ON LABEL	16. PHONE NUMBER (847) 678-0685	17. FAX NUMBER (847) 678-0685
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.

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 12/26/2007	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT TYNA GAWRYLISZYN

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 02/06/2008	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY
QUALIFICATIONS Other (When new labels are printed, the class and type statement on the label indicated as "other" must be changed to read "Brandy with natural 'flavors' added.") Other (The finished product must be 'thujone-free' pursuant to 21 CFR 172.510.) STATUS THE STATUS IS EXPIRED. CLASS/TYPE DESCRIPTION OTHER SPECIALTIES & PROPRIETARIES	EXPIRATION DATE (If any) 08/06/2008

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AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 2.8 inches W X 4.91 inches H

Image Type:

Back
Actual Dimensions: 2 inches W X 3.73 inches H

Image Type:

Other
Actual Dimensions: 1.9 inches W X 1.4 inches H

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