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 16069001000115
1. REP. ID. NO. (If any) CT 171 OR 5E

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required) NY-I-15204 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) PERNOD RICARD USA, PERNOD RICARD USA, LLC 100 MANHATTANVILLE RD , LEGAL DEPT PURCHASE NY 10577 JOHN JAMESON IMPORT COMPANY (Used on label)
4. SERIAL NUMBER (Required) 16P044 5. TYPE OF PRODUCT (Required) WINE DISTILLED SPIRITS MALT BEVERAGE
6. BRAND NAME (Required) JAMESON	8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any) THE DISTILLER'S SAFE

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 750 MILLILITERS	13. ALCOHOL CONTENT 43	14. WINE APPELLATION IF ON LABEL
15. WINE VINTAGE DATE IF ON LABEL	16. PHONE NUMBER (914) 467-2220	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. PRODUCT OF IRELAND - JOHN JAMESON AND SON ARE EMBOSSED AROUND THE BOTTOM OF THE BOTTLE. SINCE 1780 IS EMBOSSED ABOVE THE BACK LABEL.

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 03/09/2016	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT KELLY VINCOLI

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 03/18/2016	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

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 SURRENDERED. CLASS/TYPE DESCRIPTION IRISH WHISKY FB

EXPIRATION DATE (If any)

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AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3.7 inches W X 4.11 inches H

Image Type:

Neck
Actual Dimensions: 0.81 inches W X 4.15 inches H

Image Type:

Back
Actual Dimensions: 2.68 inches W X 3.18 inches H

Image Type:

Back
Actual Dimensions: 2.57 inches W X 0.46 inches H

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