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
23137001000852
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1. REP. ID. NO. (If any)
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CT
109
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OR
13
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PART I - APPLICATION
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2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
DSP-CO-20042
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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)
Old Elk Distilleries, LLC
1713 E LINCOLN AVE UNIT B2
Fort Collins
CO
80524
OLD ELK DISTILLERY (Used on label)
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4. SERIAL NUMBER (Required)
23BP06
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5. TYPE OF PRODUCT (Required)
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6. BRAND NAME (Required)
OLD ELK
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8a. MAILING ADDRESS, IF DIFFERENT
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7. FANCIFUL NAME (If any)
AQUA VITAE VOL #2
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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
(970) 494-5814
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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 GRAPHICS, SALUTATIONS, DATES, PROOF, AND ARTWORK PRESENTED ON THIS LABEL MAY BE CHANGED TO PERSONALIZE THIS LABEL. THE PROOF, ABV, BOTTLE SIZE, BARREL NUMBER, AGE, SERIES, BOTTLER, AND MASH BILL WILL BE HANDWRITTEN ON THE LABEL.
THE WORDS "OLD ELK DISTILLERY" AND THREE STARS WILL BE EMBOSSED ON THE BACK OF THE BOTTLE. THERE IS ALSO AN EMBOSSED CIRCULAR "OE" ON THE BACK OF THE BOTTLE.
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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
05/17/2023
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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
Danielle
Bzdok
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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
05/19/2023
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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
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.
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
OTHER STRAIGHT WHISKY
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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: 2.5 inches W X 2.8 inches H
Image Type:
Brand (front) or keg collar
Actual Dimensions: 2 inches W X 0.7 inches H
Image Type:
Neck
Actual Dimensions: 4.55 inches W X 1 inches H
Image Type:
Back
Actual Dimensions: 2.5 inches W X 2.8 inches H
Image Type:
Other
Actual Dimensions: 2.5 inches W X 0.75 inches H
Image Type:
Other
Actual Dimensions: 0.63 inches W X 0.63 inches H
Image Type:
Other
Actual Dimensions: 1.75 inches W X 1.75 inches H
Image Type:
Other
Actual Dimensions: 2.5 inches W X 2.3 inches H
TTB F 5100.31 (06-2016) PREVIOUS EDITIONS ARE OBSOLETE