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
14275001000251
|
1. REP. ID. NO. (If any)
|
CT
149
|
OR
44
|
|
PART I - APPLICATION
|
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-TX-15018
|
3. SOURCE OF PRODUCT (Required)
|
|
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)
BALCONES DISTILLING LLC
212 S 17TH ST
WACO
TX
76701
BALCONES DISTILLING (Used on label)
|
4. SERIAL NUMBER (Required)
14SBSS
|
5. TYPE OF PRODUCT (Required)
|
|
6. BRAND NAME (Required)
BALCONES
|
8a. MAILING ADDRESS, IF DIFFERENT
|
7. FANCIFUL NAME (If any)
TEXAS SINGLE MALT 2014 STAFF SELECTION
|
9. EMAIL ADDRESS
|
10. GRAPE VARIETAL(S) (Wine Only)
N/A
|
11. FORMULA
|
18. TYPE OF APPLICATION (Check applicable box(es))
|
12. NET CONTENTS
750 MILLILITERS
|
13. ALCOHOL CONTENT
60
|
14. WINE APPELLATION IF ON LABEL
|
15. WINE VINTAGE DATE IF ON LABEL
|
16. PHONE NUMBER
(203) 558-3239
|
17. FAX NUMBER
(888) 859-0023
|
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.
"BALCONES EST. 2008" "TEXAS"
|
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
10/02/2014
|
21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
|
22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
Keith
Bellinger
|
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
11/22/2014
|
24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
|
FOR TTB USE ONLY
|
QUALIFICATIONS
INFORMATION RETRIEVED FROM THE QR CODE, MICROSOFT TAG OR NEAR-FIELD COMMUNICATION TAG MUST BE IN COMPLIANCE WITH ALL ADVERTISING REGULATIONS.
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
OTHER WHISKY (FLAVORED)
|
EXPIRATION DATE (If any)
|
AFFIX COMPLETE SET OF LABELS BELOW
Image Type:
Brand (front) or keg collar
Actual Dimensions: 3 inches W X 4 inches H
Image Type:
Strip
Actual Dimensions: 3 inches W X 0.5 inches H
Image Type:
Back
Actual Dimensions: 3 inches W X 4 inches H
TTB F 5100.31 (07/2012) PREVIOUS EDITIONS ARE OBSOLETE