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
24170001000265

1. REP. ID. NO. (If any)
CT
493

OR
7T

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required)
FL-I-15704
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)

PARK STREET IMPORTS LLC
1000 BRICKELL AVE STE 215

MIAMI FL 33131

4. SERIAL NUMBER (Required)
24CUVE

5. TYPE OF PRODUCT (Required)
WINE
DISTILLED SPIRITS
MALT BEVERAGE

6. BRAND NAME (Required)
BOUKMAN
8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any)
CUVEE AMBREE
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
(305) 400-8324
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.

cuvee - vintage // ambree - amber // koute vwa la libete kap chante lan ke nou - listen to the voice of freedom singing that we // respe - respect// hounneur - honnor // tunion fait la force - union is strength //
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
06/18/2024
17. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT
(Application was e-filed)
18. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT
HARALD KOHLMANN
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
06/21/2024
20. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Authorized Signature

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. (Second front label displays alcohol content)
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

EXPIRATION DATE (If any)

AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 4 inches W X 6 inches H


Label Image: Brand (front) or keg collar


Image Type:

Brand (front) or keg collar
Actual Dimensions: 7 inches W X 2 inches H


Note: The image below has been reduced to fit the page. See actual dimensions above.
Label Image: Brand (front) or keg collar


Image Type:

Back
Actual Dimensions: 4 inches W X 5 inches H


Label Image: Back


Image Type:

Other
Actual Dimensions: 4 inches W X 5 inches H


Label Image: Other




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