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

15212001000511

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

641

PART I - APPLICATION

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

DSP-TX-20019

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)

FRUITIKI INCORPORATED
2211 TEXAS AVE

EL PASO TX 79901

FRUITIKI INC. (Used on label)

4. SERIAL NUMBER (Required)

15CREA

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

BUZZ BAR

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

CREAMY COOKIE

9. EMAIL ADDRESS

10. GRAPE VARIETAL(S) (Wine Only)

N/A

11. FORMULA

1189638

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 ____ 100 ML_____ (Fill in amount)
d.	RESUBMISSION AFTER REJECTION TTB ID. NO. ______

12. NET CONTENTS

100 MILLILITERS

13. ALCOHOL CONTENT

2.05

14. WINE APPELLATION IF ON LABEL

15. WINE VINTAGE DATE IF ON LABEL

16. PHONE NUMBER

(310) 738-0620

17. FAX NUMBER

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.

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 07/31/2015	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT Susan Bryant

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 09/09/2015	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

Information on Social Media sites, such as: FACEBOOK and/or TWITTER, as well as, information contained on apps referenced on the label, must be in compliance with all labeling and advertising regulations.
The disclosure of allergens used in this product is voluntary, pending final rulemaking (See Notice No. 62, 71 FR 42329). However; any reference made to allergens must declare all allergens used in the production of this product, including fining or processing agents.
Approved pending rulemaking on statements of average analysis.
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 SURRENDERED.

CLASS/TYPE DESCRIPTION

WHISKY SPECIALTIES

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 7.84 inches W X 9.31 inches H

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

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