OMB No. 1513-0020

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

23191001001072

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

140

PART I - APPLICATION

2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)

DSP-TX-20252

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)

Texas Black Gold Distillery, TEXAS BLACK GOLD DISTILLERY, LLC
2222 STUDEWOOD ST UNIT B

HOUSTON TX 77009

TEXAS BLACK GOLD DISTILLERY,LLC (Used on label)

4. SERIAL NUMBER (Required)

232410

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

TEXAS BLACK GOLD DISTILLERY

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

F.W. 1998 WHISKEY

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

(832) 978-8308

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.

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 07/10/2023	17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT dustin jackson

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 07/17/2023	20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

THE STRIP LABEL DISPLAYS ONE OR MORE PIECES OF MANDATORY LABEL INFORMATION THAT MUST BE SHOWN IN THE SAME FIELD OF VIEW ON THE CONTAINER: (1) BRAND NAME, (2) CLASS OR TYPE OF DISTILLED SPIRITS, AND (3) ALCOHOL CONTENT STATEMENT. ENSURE STRIP LABEL IS PLACED SUCH THAT THE CONTAINER DOES NOT NEED TO BE TURNED TO VIEW THESE PIECES OF INFORMATION. (Neck label displays brand name)
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

WHISKY

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3 inches W X 3.5 inches H

Label Image: Brand (front) or keg collar

Image Type:

Back
Actual Dimensions: 3 inches W X 3 inches H

Label Image: Back

Image Type:

Neck
Actual Dimensions: 2 inches W X 0.75 inches H

Label Image: Neck

Image Type:

Other
Actual Dimensions: 1 inches W X 1 inches H

Label Image: Other

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