OMB No. 1513-0020
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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
24165001000864
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1. REP. ID. NO. (If any)
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CT
493
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OR
7T
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PART I - APPLICATION
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2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
FL-I-15704
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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)
PARK STREET IMPORTS LLC
1000 BRICKELL AVE STE 215
MIAMI
FL
33131
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4. SERIAL NUMBER (Required)
24BOUK
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5. TYPE OF PRODUCT (Required)
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6. BRAND NAME (Required)
BOUKMAN
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8a. MAILING ADDRESS, IF DIFFERENT
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7. FANCIFUL NAME (If any)
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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
(305) 400-8324
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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.
koute vwa la libete kap chante lan ke nou - listen to the voice of freedom singing that we //
boukman - bookish //
ambree - amber //
cuvee - vintage //
respe - respect //
honeur - honor //
tunion fait la force - union fait la force//
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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
06/13/2024
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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
HARALD
KOHLMANN
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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
06/17/2024
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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
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. (Second front label displays alcohol content)
INFORMATION RETRIEVED FROM THE QR CODE, MICROSOFT TAG OR NEAR-FIELD COMMUNICATION TAG MUST BE IN COMPLIANCE WITH ALL ADVERTISING REGULATIONS.
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 RUM GOLD FB
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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: 4 inches W X 6 inches H
Image Type:
Brand (front) or keg collar
Actual Dimensions: 6 inches W X 2 inches H
Image Type:
Other
Actual Dimensions: 5 inches W X 5 inches H
Image Type:
Back
Actual Dimensions: 4 inches W X 5 inches H
TTB F 5100.31 (06-2016) PREVIOUS EDITIONS ARE OBSOLETE