OMB No. 1513-0020 (07/31/2015)
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FOR TTB USE ONLY
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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)
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TTB ID
13113001000021
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1. REP. ID. NO. (If any)
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CT
140
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OR
22
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PART I - APPLICATION
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2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-AR-3
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3. SOURCE OF PRODUCT (Required)
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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)
PERNOD RICARD USA, PERNOD RICARD USA BOTTLING, LLC
7401 HIGHWAY 45 S
FORT SMITH
AR
72916
WILD TURKEY DISTILLING COMPANY (Used on label)
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4. SERIAL NUMBER (Required)
13P099
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5. TYPE OF PRODUCT (Required)
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6. BRAND NAME (Required)
WILD TURKEY
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8a. MAILING ADDRESS, IF DIFFERENT
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7. FANCIFUL NAME (If any)
FORGIVEN
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9. EMAIL ADDRESS
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10. GRAPE VARIETAL(S) (Wine Only)
N/A
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11. FORMULA
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18. TYPE OF APPLICATION (Check applicable box(es))
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12. NET CONTENTS
375 MILLILITERS
750 MILLILITERS
1 LITER
1.75 LITERS
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13. ALCOHOL CONTENT
45.5
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14. WINE APPELLATION IF ON LABEL
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15. WINE VINTAGE DATE IF ON LABEL
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16. PHONE NUMBER
(914) 467-2220
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17. FAX NUMBER
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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.
THE "TURKEY" LOGO IS EMBOSSED ONTO THE CORK. "WILD TURKEY 1855" CIRCLE IS EMBOSSED ONTO THE SHOULDER OF THE GLASS. BOTTLES WILL BE CODED AS TO BOTTLING LOCATION. PERNOD RICARD USA, LLC IS THE CONTRACT BOTTLER FOR THE BRAND OWNER, WILD TURKEY DISTILLING COMPANY, LAWRENCEBURG, KY. THE ADDRESS STATED ON THE LABEL IS THE PROPRIETOR'S PREMISE ADDRESS OF WHERE DISTILLING/BLENDING OPERATIONS OCURRED.
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PART II - APPLICANT'S CERTIFICATION
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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.
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20. DATE OF APPLICATION
04/23/2013
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21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
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22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
KELLY
VINCOLI
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PART III - TTB CERTIFICATE
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This certificate is issued subject to applicable laws, regulations and conditions as set forth in the instructions portion of this form.
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23. DATE ISSUED
05/28/2013
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24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
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FOR TTB USE ONLY
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QUALIFICATIONS
EACH CONTAINER MUST BE CODED TO INDICATE ACTUAL PLACE OF BOTTLING.
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
APPROVED.
CLASS/TYPE DESCRIPTION
WHISKY
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EXPIRATION DATE (If any)
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AFFIX COMPLETE SET OF LABELS BELOW
Image Type:
Brand (front) or keg collar
Actual Dimensions: 3.04 inches W X 1.80 inches H
Image Type:
Back
Actual Dimensions: 2.80 inches W X 1.40 inches H
Image Type:
Neck
Actual Dimensions: 4.51 inches W X 1.23 inches H
TTB F 5100.31 (07/2012) PREVIOUS EDITIONS ARE OBSOLETE