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 20077001000607
1. REP. ID. NO. (If any) CT 102 OR 22

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required) DSP-KY-14 DSP-KY-230 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. 3200 GEORGETOWN RD FRANKFORT KY 40601 A. OVERHOLT & CO. (Used on label)
4. SERIAL NUMBER (Required) 200012 5. TYPE OF PRODUCT (Required) WINE DISTILLED SPIRITS MALT BEVERAGE
6. BRAND NAME (Required) OLD OVERHOLT	8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)

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) 774-6806	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 CONTENT MAY OR MAY NOT BE BLOWN OR BRANDED INTO THE CONTAINER. INFORMATION LISTED ON NECK LABEL MAY OR MAY NOT APPEAR OR MAY OR MAY NOT BE REPEATED IN ANY OR MULTIPLE LOCATIONS.

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 03/17/2020	17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT Terri Hall

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 04/06/2020	20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

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 RYE WHISKY

EXPIRATION DATE (If any)

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AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 4.5 inches W X 5 inches H

Image Type:

Back
Actual Dimensions: 2.37 inches W X 3 inches H

Image Type:

Neck
Actual Dimensions: 4.5 inches W X 2.25 inches H

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