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)
CT
641

OR
44

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
Authorized Signature

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