OMB No. 1513-0020

OMB No. 1513-0020 (01/31/2009)

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

12012001000199

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

101

PART I - APPLICATION

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

DSP-KY-8
DSP-KY-62

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)

FOUR ROSES DISTILLERY LLC
1224 BONDS MILL RD

LAWRENCEBURG KY 40342

4. SERIAL NUMBER (Required)

12001L

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

FOUR ROSES

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

LIMITED EDITION SMALL BATCH

9. EMAIL ADDRESS

10. GRAPE VARIETAL(S) (Wine Only)

N/A

11. FORMULA

18. 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. ______

12. NET CONTENTS

750 MILLILITERS

13. ALCOHOL CONTENT

14. WINE APPELLATION IF ON LABEL

15. WINE VINTAGE DATE IF ON LABEL

16. PHONE NUMBER

(202) 449-3739

17. FAX NUMBER

(202) 478-5189

19. SHOW ANY WORDING (a) APPEARING ON MATERIALS FIRMLY AFFIXED TO THE CONTAINER (e.g., caps, celoseals, corks, etc.) OTHER THAN THE LABLES AFFIXED BELOW, OR (b) BLOWN, BRANDED OR EMBOSSED ON THE CONTAINER (e.g., net contents etc.). THIS WORDING MUST BE NOTED HERE EVEN IF IT DUPLICATES PORTIONS OF THE LABELS AFFIXED BELOW. ALSO, PROVIDE TRANSLATIONS OF FOREIGN LANGUAGE TEXT APPEARING ON LABELS.
BRAND NAME, LOGO AND GRAPHICS MAY REPEAT. OPTIONAL: BOTTLES MAY BE SIGNED BY DISTILLER. THE FOLLOWING TO BE HAND-WRITTEN ON EACH LABEL AND MAY CHANGE: ALCOHOL CONTENT (NOT LESS THAN 40% ABV), BOTTLE NUMBER. PLEASE SEE THE OTHER ATTACHMENTS FOR NON-PAPER LABELING.

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.
20. DATE OF APPLICATION 01/12/2012	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT ROBERT LEHRMAN

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.
23. DATE ISSUED 01/30/2012	24. 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 BOURBON WHISKY

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3.09 inches W X 4.94 inches H

Label Image: Brand (front) or keg collar

Image Type:

Back
Actual Dimensions: 3.52 inches W X 5.18 inches H

Label Image: Back

Image Type:

Other
Actual Dimensions: 1.50 inches W X 1.19 inches H

Label Image: Other

TTB F 5100.31 (5/2011) PREVIOUS EDITIONS ARE OBSOLETE