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
16168001000175

1. REP. ID. NO. (If any)
1165
CT
153

OR
5K

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
IL-I-198
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)

JIM BEAM BRANDS CO.
510 LAKE COOK RD

DEERFIELD IL 60015

LAPHROAIG IMPORT COMPANY (Used on label)
4. SERIAL NUMBER (Required)
160113

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

6. BRAND NAME (Required)
LAPHROAIG
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
750 MILLILITERS
1.75 LITERS
1 LITER
375 MILLILITERS
200 MILLILITERS
100 MILLILITERS
50 MILLILITERS
13. ALCOHOL CONTENT
53.5
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 ROPP TOP 557689F CAP FILED AS OTHER: THE FOLLOWING TEXT/GRAPHIC MAY OR MAY NOT APPEAR OR MAY OR MAY NOT BE REPEATED ON THE CLOSURE IN ANY OR MULTIPLE LOCATION(S): 1)LAPHROAIG 2) DISTILLERY 3)POT STILL GRAPHIC; JPEG ROPP CLOSURE 557689E WRAP FILED AS NECK: THE FOLLOWING TEXT MAY OR MAY NOT APPEAR OR MAY OR MAY NOT BE REPEATED ON THE NECK IN ANY OR MULTIPLE LOCATION(S): 1)ESTABLISHED 1815; JPEG LP CORK FILED AS OTHER: THE FOLLOWING TEXT/GRAPHIC MAY OR MAY NOT APPEAR OR MAY OR MAY NOT BE REPEATED ON THE CLOSURE IN ANY OR MULTIPLE LOCATION(S): 1)LAPHROAIG; 2)DISTILLERY; 3)POT STILL GRAPHIC:
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
06/16/2016
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
07/12/2016
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
SINGLE MALT SCOTCH WHISKY

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front)
Actual Dimensions: 3.18 inches W X 1.18 inches H


Label Image: Brand (front)


Image Type:

Brand (front)
Actual Dimensions: 3.18 inches W X 3.47 inches H


Label Image: Brand (front)


Image Type:

Back
Actual Dimensions: 2.51 inches W X 5.05 inches H


Label Image: Back


Image Type:

Neck
Actual Dimensions: 3.97 inches W X 1.88 inches H


Label Image: Neck


Image Type:

Other
Actual Dimensions: 1.19 inches W X 1.19 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 2.01 inches W X 2.01 inches H


Label Image: Other




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