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
19050001000119

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

OR
5K

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
CT-I-15074
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)

DIAGEO AMERICAS SUPPLY, INC.
801 MAIN AVE

NORWALK CT 06851

4. SERIAL NUMBER (Required)
19R017

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

6. BRAND NAME (Required)
LAGAVULIN
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
OFFERMAN EDITION
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
(815) 267-4752
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.
CONTAINERS WILL BE CODED FOR IDENTIFICATION PURPOSES AND BOTTLING FACILITY. BOTTLE DEPOSIT INFORMATION MAY/MAY NOT APPEAR ON THE LABEL AND/OR CONTAINER. CLOSURE AND/OR CONTAINER MAY/MAY NOT CONTAIN BRAND GRAPHICS/LOGOS/EMBOSSING. KOSHER SYMBOL MAY/MAY NOT APPEAR ON LABEL. THE GRAPHICS, SALUTATIONS, DATES, AND ARTWORK PRESENTED ON THIS LABEL MAY BE CHANGED TO PERSONALIZE THIS LABEL. THE PERSONALIZED INFORMATION MAY/MAY NOT BE ETCHED ON THE BOTTLE.
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
02/19/2019
17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
Lorrie Williams
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
02/28/2019
20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Authorized Signature

FOR TTB USE ONLY
QUALIFICATIONS
This approval to change the personalizing information does not permit the addition of any information that discusses either the alcohol beverage or characteristics of the alcohol beverage or that is inconsistent with or in violation of the provisions of 27 CFR parts 4, 5, 7 or 16, as applicable, or any other applicable provision of law or regulations.
The approval of this COLA covers this label and any additions, deletions or changes in graphics, salutations, congratulatory dates and names, and artwork to personalize the label as indicated on the application.
EACH CONTAINER MUST BE CODED TO INDICATE ACTUAL PLACE OF BOTTLING.
It is the responsibility of the COLA holder to ensure that the appropriate authorization is obtained for the use of the person and/or organization depicted on the label. The authorization must be kept at the permittee's address and made available for review upon request.
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) or keg collar
Actual Dimensions: 4.7 inches W X 2.6 inches H


Label Image: Brand (front) or keg collar


Image Type:

Back
Actual Dimensions: 3.7 inches W X 2.5 inches H


Label Image: Back


Image Type:

Neck
Actual Dimensions: 1.5 inches W X 2.9 inches H


Label Image: Neck




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