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
18057001000228

1. REP. ID. NO. (If any)
CT
101

OR
22

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-KY-414
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)

BROWN-FORMAN CORPORATION
1908 HOWARD ST , SHIP TO: 2921 DIXIE HWY

LOUISVILLE KY 40210

OLD FORESTER DISTILLING CO. (Used on label)
4. SERIAL NUMBER (Required)
180013

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

6. BRAND NAME (Required)
OLD FORESTER
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
BIRTHDAY BOURBON 2018
9. FORMULA
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
(502) 774-7324
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.
NET CONTENTS ARE BLOWN INTO THE BOTTLE 750ML
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
02/26/2018
17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
MARY DILLARD
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
02/28/2018
20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Authorized Signature

FOR TTB USE ONLY
QUALIFICATIONS
Approved despite that your Government Warning Statement which needs to appear separate and apart from all additional text. One character space should completely surround the government warning statement. When labels are printed, please make the necessary correction. (Prior to printing, please move the responsibility web address, it should not appear as part of the Government Warning. )
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

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front)
Actual Dimensions: 2.96 inches W X 1.59 inches H


Label Image: Brand (front)


Image Type:

Neck
Actual Dimensions: 4.76 inches W X 1.12 inches H


Label Image: Neck


Image Type:

Strip
Actual Dimensions: 8.74 inches W X 0.86 inches H


Note: The image below has been reduced to fit the page. See actual dimensions above.
Label Image: Strip


Image Type:

Back
Actual Dimensions: 3.69 inches W X 1.37 inches H


Label Image: Back




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