OMB No. 1513-0020
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
17215001000904

1. REP. ID. NO. (If any)
CT
641

OR
22

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-KY-67
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)

WILD TURKEY DISTILLERY, CAMPARI AMERICA LLC
1417 VERSAILLES RD

LAWRENCEBURG KY 40342

WILD TURKEY DISTILLING COMPANY (Used on label)
4. SERIAL NUMBER (Required)
170007

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

6. BRAND NAME (Required)
WILD TURKEY
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
REVIVAL
9. FORMULA
1275989
10. GRAPE VARIETAL(S) (Wine Only)
N/A
14. 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. ______
11. WINE APPELLATION (If on label)
12. PHONE NUMBER
(415) 315-8000
13. EMAIL ADDRESS
 
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.
IMAGE OF TURKEY IS EMBOSSED ON THE GLASS. BATCH NUMBER AND/OR BOTTLE NUMBER MAY VARY AND CHANGE. FONT TYPE FOR THE ALCOHOL CONTENT AND PROOF STATEMENT MAY VARY, BUT SIZE WILL MEET 2MM MINIMUM TYPE SIZE REQUIREMENT. BRAND NAME, FANCIFUL NAME, PRODUCER/BOTTLER, LOGO, AND/OR GRAPHICS AND TEXT EXISTING ON THE LABELS MAY REPEAT ON THE CAP, CAPSULE, NECK, STRIP LABEL, AND/OR BOTTLE. LOT NUMBER AND DATE BOTTLED MAY BE PRINTED AFTER BOTTLING. ALL LABEL INFORMATION MAY BE COMBINED INTO 1 LABEL FOR 50ML SIZE.
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.
16. DATE OF APPLICATION
08/03/2017
17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
Felica Losongco
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.
19. DATE ISSUED
08/28/2017
20. 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
WHISKY SPECIALTIES

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 4.34 inches W X 0.8 inches H


Label Image: Brand (front) or keg collar


Image Type:

Brand (front) or keg collar
Actual Dimensions: 2.18 inches W X 1.65 inches H


Label Image: Brand (front) or keg collar


Image Type:

Back
Actual Dimensions: 2.34 inches W X 2.12 inches H


Label Image: Back


Image Type:

Other
Actual Dimensions: 4.05 inches W X 4.22 inches H


Label Image: Other


Image Type:

Other
Actual Dimensions: 1.18 inches W X 0.62 inches H


Label Image: Other




TTB F 5100.31 (06-2016)    PREVIOUS EDITIONS ARE OBSOLETE