OMB No. 1513-0020
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FOR TTB USE ONLY
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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)
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TTB ID
17031001000063
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1. REP. ID. NO. (If any)
1165
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CT
101
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OR
22
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PART I - APPLICATION
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2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-KY-230
DSP-KY-14
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3. SOURCE OF PRODUCT (Required)
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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.
3200 GEORGETOWN RD
FRANKFORT
KY
40601
KNOB CREEK DISTILLERY (Used on label)
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4. SERIAL NUMBER (Required)
170011
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5. TYPE OF PRODUCT (Required)
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6. BRAND NAME (Required)
KNOB CREEK
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8a. MAILING ADDRESS, IF DIFFERENT
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7. FANCIFUL NAME (If any)
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9. FORMULA
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10. GRAPE VARIETAL(S) (Wine Only)
N/A
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14. TYPE OF APPLICATION (Check applicable box(es))
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11. WINE APPELLATION (If on label)
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12. PHONE NUMBER
(502) 215-2123
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13. EMAIL ADDRESS
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15. 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.
ARTWORK MAY BE APPLIED DIRECTLY TO CONTAINER (SUCH AS SILKSCREEN)OR APPLIED
VIA LABEL.
THE "BARRELED DATE" PRESENTED ON THIS LABEL WILL BE CHANGED TO PERSONALIZE THIS LABEL. THE DATE WILL BE CHANGED INCREMENTALLY TO INDICATE PERSONALIZATION. THE PROOF,AND ARTWORK PRESENTED ON THIS LABEL(JPEG FA110-KCA011) LOADED AS BRAND FRONT)MAY BE CHANGED TO PERSONALIZE THIS LABEL.
JPEG 515874A FILED AS OTHER: THE FOLLOWING MAY OR MAY NOT APPEAR ON WAX SEAL (STAMPED INTO WAX AT NECK) AND MAY OR MAY NOT BE REPEATED ON WAX SEAL (STAMPED INTO WAX AT NECK): 1.KNOB CREEK 2. SMALL BATCH 3. CLERMONT KENTUCKY 4. DISTILLED IN LIMITED QUANTITIES
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PART II - APPLICANT'S CERTIFICATION
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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.
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16. DATE OF APPLICATION
01/31/2017
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17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
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18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
Jennifer
Alexander
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PART III - TTB CERTIFICATE
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This certificate is issued subject to applicable laws, regulations and conditions as set forth in the instructions portion of this form.
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19. DATE ISSUED
02/06/2017
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20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
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FOR TTB USE ONLY
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QUALIFICATIONS
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
STRAIGHT BOURBON WHISKY
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EXPIRATION DATE (If any)
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AFFIX COMPLETE SET OF LABELS BELOW
Image Type:
Brand (front) or keg collar
Actual Dimensions: 5.2 inches W X 1.07 inches H
Image Type:
Brand (front) or keg collar
Actual Dimensions: 2.79 inches W X 2.16 inches H
Image Type:
Other
Actual Dimensions: 2.25 inches W X 3.26 inches H
Image Type:
Back
Actual Dimensions: 1.15 inches W X 2.79 inches H
TTB F 5100.31 (06-2016) PREVIOUS EDITIONS ARE OBSOLETE