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
15153001000120

1. REP. ID. NO. (If any)
1165
CT
101

OR
22

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-KY-20029
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)

JAMES B BEAM DISTILLING CO., JIM BEAM BRANDS CO.
410 S 4TH ST

LOUISVILLE KY 40202

JAMES B. BEAM DISTILLING CO. (Used on label)
4. SERIAL NUMBER (Required)
150084

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

6. BRAND NAME (Required)
JIM BEAM
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
9. EMAIL ADDRESS
 
10. GRAPE VARIETAL(S) (Wine Only)
N/A
11. FORMULA
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
375 MILLILITERS
13. ALCOHOL CONTENT
50
14. WINE APPELLATION IF ON LABEL
15. WINE VINTAGE DATE IF ON LABEL
16. PHONE NUMBER
(502) 215-2120
17. FAX NUMBER
(502) 215-2199
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 CONTENT MAY OR MAY NOT BE BLOWN OR BRANDED INTO THE CONTAINER. JPEG USH375 LOWER LABEL STEEL FILED AS BRAND FRONT: THE "BOTTLING DATE AND LOT NUMBER" WILL BE CHANGED TO PERSONALIZE THIS LABEL. JPEG USH375 STRIP STAMP FILED AS STRIP STAMP; THE SERIAL NO. WILL BE CHANGED BASED ON THE BATCH TO PERSONALIZE THIS LABEL. THE FOLLOWING MAY OR MAY NOT APPEAR AND MAY OR MAY NOT BE REPEATED IN ANY OR MULTIPLE LOCATION(S)ON THE STRIP STAMP; 1) URBAN STILLHOUSE; 2) LOUISVILLE KY; 3) STATE OF KENTUCKY GRAPHIC; 4) SERIAL NO.; 5) TIME-HONORED FAMILY RECIPE; 6) BARREL GRAPHIC 7) SINCE 1795 8) STEEL STAMPED
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
06/02/2015
21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
Jennifer Alexander
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
06/06/2015
24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Authorized Signature

FOR TTB USE ONLY
QUALIFICATIONS
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
STRAIGHT BOURBON WHISKY

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front)
Actual Dimensions: 6.25 inches W X 1.08 inches H


Note: The image below has been reduced to fit the page. See actual dimensions above.
Label Image: Brand (front)


Image Type:

Brand (front)
Actual Dimensions: 2.5 inches W X 1.75 inches H


Label Image: Brand (front)


Image Type:

Strip
Actual Dimensions: 4.25 inches W X 0.35 inches H


Label Image: Strip




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