OMB No. 1513-0020

OMB No. 1513-0020 (07/31/2015)

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

12307001000034

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

649

PART I - APPLICATION

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

DSP-TN-4

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)

JACK DANIEL DISTILLERY, LEM MOTLOW PROPRIETOR, BROWN-FORMAN CORPORATION
280 LYNCHBURG HWY

LYNCHBURG TN 37352

JACK DANIEL DISTILLERY (Used on label)

4. SERIAL NUMBER (Required)

120118

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

JACK DANIEL'S

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

UNAGED RYE

9. EMAIL ADDRESS

10. GRAPE VARIETAL(S) (Wine Only)

N/A

11. FORMULA

1172912

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

750 MILLILITERS

13. ALCOHOL CONTENT

14. WINE APPELLATION IF ON LABEL

15. WINE VINTAGE DATE IF ON LABEL

16. PHONE NUMBER

(502) 774-7324

17. FAX NUMBER

(502) 774-7188

19. SHOW ANY INFORMATION THAT IS BLOWN, BRANDED, OR EMBOSSED ON THE CONTAINER (e.g., net contents) ONLY IF IT DOES NOT APPEAR ON THE LABELS AFFIXED BELOW. ALSO, SHOW TRANSLATIONS OF FOREIGN LANGUAGE TEXT APPEARING ON LABELS.
NET CONTENTS IS BLOWN INTO THE BOTTLE. "JACK DANIEL" IS BLOWN INTO THE BOTTLE FOUR TIMES.

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 11/02/2012	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT MARY DILLARD

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 11/28/2012	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

Other (Labels which are not an integral part of the bottle (see class and type designation) shall be affixed to bottles in such manner that they cannot be removed without thorough application of water or other solvents)
This certificate is operative for the release of not more than the following number of bottle cases/ kegs. (20,845 cases)
NO MORE USE-UPS WILL BE GRANTED.
TTB has not reviewed this label for type size, characters per inch or contrasting background. The responsible industry member must continue to ensure that the mandatory information on the actual labels is displayed in the correct type size, number of characters per inch, and on a contrasting background in accordance with the TTB labeling regulations, 27 CFR parts 4, 5, 7, and 16, as applicable.

STATUS

THE STATUS IS EXPIRED.

CLASS/TYPE DESCRIPTION

OTHER SPECIALTIES & PROPRIETARIES

EXPIRATION DATE (If any)

05/28/2013

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 04.13 inches W X 01.02 inches H

Label Image: Brand (front) or keg collar

Image Type:

Brand (front) or keg collar
Actual Dimensions: 06.10 inches W X 01.26 inches H

Label Image: Brand (front) or keg collar

Image Type:

Back
Actual Dimensions: 02.32 inches W X 01.30 inches H

Label Image: Back

TTB F 5100.31 (07/2012) PREVIOUS EDITIONS ARE OBSOLETE