Form TTB F 5154.1 TTB F 5154.1 Formula and Proces for Non Beverage Product

20%1R9/30/2011

)2508/$180%(5

'(3$570(172)7+(75($685<
$/&2+2/$1'72%$&&27$;$1'75$'(%85($8

)2508/$$1'352&(66)25121%(9(5$*(352'8&7

.,1'(e.g. Alcohol, Rum) 
3522)63,5,7621:+,&+
180%(52)'$<6 '5$:%$&.:,//%(&/$,0('
72&203/(7(
352&(66

(See instructions after page 2. Prepare in triplicate except as indicated.) 
&+(&.,)
6$03/(:,//
%(68%0,77('

1$0(2)352'8&7

1$0(2)0$18)$&785(5 $''5(66:+(5(352'8&7:,//%(
352'8&('(If multiple production sites, list other addresses in item 22.)

&+(&..,1'2)352'8&7
)2508/$6 683(56('('
0(',&,1(0(',&,1$/35(3$5$7,21
)/$925)/$925,1*(;75$&7
)22'352'8&73(5)80(
DIETARY SUPPLEMENT
(/,*,%/($%62/87($/&2+2/%<
92/80(86('6HHinstructions)

$/&2+2/&217(17%<92/80(
2)),1,6+('352'8&7










,)0$'(:,7+5(&29(5('63,5,76 ,)),1,6+('352'8&7,672%(86(',1$/&2+2/,&%(9(5$*(6
(/,*,%/(3/865(&29(5('$%62 
/87($/&2+2/%<92/80(86(' $'2(6352'8&7&217$,11$785$/)/$925,1*"<(62512BBBBBBBBBBBB
%'2(6352'8&7&217$,1*5($7(57+$1.$57,),&,$/)/$925,1*([FOXGLQJ9DQLOOLQ(WK\O9DQLOOLQ0DOWRODQG
(See instructions)
(WK\O0DOWRO"<(62512BBBBBBBBBB
&67$7(3$5763(50,//,21,1352'8&72)6<17+(7,&9$1,//,1BBBBBBBBB(7+File Typeapplication/pdfFile TitleTTB 5154.1.pubAuthorrtheyelFile Modified2011-07-25File Created2008-09-10