OMB No. 1513-0020
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
20188001000676
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1. REP. ID. NO. (If any)
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CT
902
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OR
29
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PART I - APPLICATION
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2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
BR-MO-BOU-1
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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)
BOULEVARD BREWING COMPANY
2501 SOUTHWEST BLVD
KANSAS CITY
MO
64108
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4. SERIAL NUMBER (Required)
200071
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5. TYPE OF PRODUCT (Required)
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6. BRAND NAME (Required)
BOULEVARD
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8a. MAILING ADDRESS, IF DIFFERENT
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7. FANCIFUL NAME (If any)
IMPERIAL CASK CUVEE
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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
(816) 701-7283
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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.
THE ATTACHED NET CONTENTS FILE IS AN EXACT, ACTUAL-SIZE IMAGE OF INFORMATION THAT IS PERMANENTLY BRANDED INTO THE CONTAINER: NET CONTENTS 15.5 U.S. GALLONS - 58 2/3 LITERS OR NET CONTENTS 5.16 U.S. GALLONS - 19 1/2 LITERS.
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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
07/06/2020
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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
Lindsey
Walser
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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
07/09/2020
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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
A STATEMENT OF NET CONTENTS MUST BE PRINTED ON LABEL, BLOWN OR BRANDED INTO THE BOTTLE OR CONTAINER. See 27 CFR 7.27
This COLA is conditioned upon compliance with TTB Ruling 2015-1
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
ALE
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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: 7 inches W X 7 inches H
Note: The image below has been reduced to fit the page. See actual dimensions above.
Image Type:
Other
Actual Dimensions: 12 inches W X 0.5 inches H
Note: The image below has been reduced to fit the page. See actual dimensions above.
TTB F 5100.31 (06-2016) PREVIOUS EDITIONS ARE OBSOLETE