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

22014001000215

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

102

PART I - APPLICATION

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

DSP-OH-15015

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)

Middle west Spirits, Middle West Spirits, LLC
1230 COURTLAND AVE

COLUMBUS OH 43201

SWEET AMBER DISTILLING CO. (Used on label)

4. SERIAL NUMBER (Required)

22003L

5. TYPE OF PRODUCT (Required)

	WINE
	DISTILLED SPIRITS
	MALT BEVERAGE

6. BRAND NAME (Required)

BLACKENED

8a. MAILING ADDRESS, IF DIFFERENT

7. FANCIFUL NAME (If any)

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

(202) 449-3739

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.
BRAND NAME, LOGO AND GRAPHICS MAY REPEAT; LOT NUMBER(S) MAY APPEAR/CHANGE. OTHER ALLOWED SIZES (SUCH AS 1 LITER, 375 ML., ETC.).

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 01/14/2022	17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	18. 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.
19. DATE ISSUED 01/20/2022	20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS

When new labels are printed the name and address statement of the responsible bottler must reflect the address on the basic permit or brewer's notice (Per letter dated January 20, 2022, the company address shall read "Columbus, OH" when new labels are printed.)
This certificate is operative for the release of not more than the following number of bottle cases/ kegs. (8,500 cases)
This use-up authorizes the depletion of product and labels that are currently in existence as of the date the use-up was requested. No additional product may be made and no additional labels may be printed.
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 EXPIRED.

CLASS/TYPE DESCRIPTION

STRAIGHT RYE WHISKY

EXPIRATION DATE (If any)

07/15/2022

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3.9 inches W X 4.3 inches H

Label Image: Brand (front) or keg collar