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

16084001000577

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

901

PART I - APPLICATION

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

BR-MO-20000
BR-CA-20002
BR-CA-20003
BR-CO-20000
BR-FL-20000
BR-GA-20001
BR-NH-20000
BR-NJ-20000
BR-NY-20000
BR-OH-20001
BR-TX-20001
BR-VA-20001

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)

ANHEUSER-BUSCH, LLC
1 BUSCH PL

SAINT LOUIS MO 63118

ANHEUSER-BUSCH (Used on label)

4. SERIAL NUMBER (Required)

16B023

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

BUDWEISER

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

12 FL. OZ.

13. ALCOHOL CONTENT

5.0

14. WINE APPELLATION IF ON LABEL

15. WINE VINTAGE DATE IF ON LABEL

16. PHONE NUMBER

(314) 577-2693

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.
FRESHNESS DATE CODE AND CONSUMER INFORMATION (PHONE NUMBER, QR CODE, AND WEBSITE). KOSHER SYMBOL IF APPLICABLE TO BRAND. ANY WORDING REQUIRED BY STATES, SUCH AS, ALCOHOL CONTENT, DEPOSIT LANGUAGE, AND CONTAINS ALCOHOL MAY BE IMPRINTED ON THE LABEL OR OTHERWISE AFFIXED TO THE BOTTLE OR CAN. RETURNABLE OR NON-RETURNABLE MAY APPEAR ON BOTTLE LABELS. PLACE/DATE OF PRODUCTION AND/OR OTHER INTERNAL MANUFACTURER CODING IS USED BY ALL BREWERIES FOR ALL PRODUCTION RUNS.

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 03/24/2016	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT ROSEMARY SCHWARTZ

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 04/11/2016	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

Approved pending rulemaking on statements of average analysis.
EACH CONTAINER MUST BE CODED TO INDICATE ACTUAL PLACE OF BOTTLING.
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

BEER

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 8.25 inches W X 4.56 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