OMB No. 1513-0020 (07/31/2015)
|
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
15286001000371
|
|
1. REP. ID. NO. (If any)
|
CT
669
|
OR
50
|
|
|
PART I - APPLICATION
|
|
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
CA-I-4520
|
3. SOURCE OF PRODUCT (Required)
|
|
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)
CAMPARI AMERICA LLC
1255 BATTERY ST , SUITE 500
SAN FRANCISCO
CA
94111
CAMPARI AMERICA (Used on label)
|
|
4. SERIAL NUMBER (Required)
150034
|
5. TYPE OF PRODUCT (Required)
|
|
|
6. BRAND NAME (Required)
CAMPARI
|
8a. MAILING ADDRESS, IF DIFFERENT
|
|
7. FANCIFUL NAME (If any)
|
|
9. EMAIL ADDRESS
|
10. GRAPE VARIETAL(S) (Wine Only)
N/A
|
11. FORMULA
|
18. TYPE OF APPLICATION (Check applicable box(es))
|
|
12. NET CONTENTS
50 MILLILITERS
100 MILLILITERS
200 MILLILITERS
375 MILLILITERS
750 MILLILITERS
1 LITER
1.75 LITERS
|
13. ALCOHOL CONTENT
24
|
14. WINE APPELLATION IF ON LABEL
|
|
15. WINE VINTAGE DATE IF ON LABEL
|
16. PHONE NUMBER
(510) 213-2295
|
17. FAX NUMBER
|
|
19. 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.
CAMPARI IS EMBOSSED ON THE LOWER FRONT OF THE BOTTLE. THE SEAL SHOWN ON THE LABELS ARE EMBOSSED ON THE LOWER BACK OF THE BOTTLE. NET CONTENT AND BOTTLE NUMBER ARE EMBOSSED ON THE BOTTOM REGION OF THE BOTTLE. LOT NUMBER AND DATE BOTTLED MAY BE PRINTED AFTER BOTTLING. ALL LABEL INFORMATION MAY BE COMBINED INTO 1 LABEL FOR 375ML OR SMALLER SIZE. DEPOSIT REFUND INFORMATION ACCOMPANYING THE WORD "REFUND" MAY BE ADDED. BRAND NAME, FANCIFUL NAME, PRODUCER, LOGO, TEXT, AND GRAPHICS MAY REPEAT ON CAP, CAPSULE, AND BOTTLE.
|
|
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
10/13/2015
|
21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
|
22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
ALICE
Chung
|
|
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
11/10/2015
|
24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
|
|
FOR TTB USE ONLY
|
|
QUALIFICATIONS
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 HERB & SEED CORDIALS/LIQUEURS
|
EXPIRATION DATE (If any)
|
AFFIX COMPLETE SET OF LABELS BELOW
Image Type:
Brand (front) or keg collar
Actual Dimensions: 3.62 inches W X 3.49 inches H
Image Type:
Other
Actual Dimensions: 1.18 inches W X 1.18 inches H
Image Type:
Back
Actual Dimensions: 2.2 inches W X 3.37 inches H
Image Type:
Other
Actual Dimensions: 3.71 inches W X 2.36 inches H
TTB F 5100.31 (07/2012) PREVIOUS EDITIONS ARE OBSOLETE