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 20188001000676
1. REP. ID. NO. (If any) CT 902 OR 29

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required) BR-MO-BOU-1 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) BOULEVARD BREWING COMPANY 2501 SOUTHWEST BLVD KANSAS CITY MO 64108
4. SERIAL NUMBER (Required) 200071 5. TYPE OF PRODUCT (Required) WINE DISTILLED SPIRITS MALT BEVERAGE
6. BRAND NAME (Required) BOULEVARD	8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any) IMPERIAL CASK CUVEE

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 (816) 701-7283	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. 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.

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 07/06/2020	17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT Lindsey Walser

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 07/09/2020	20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

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

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.

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