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Ng and Formulation Division (ALFD), TTB, 1310 G Street, N.W., Suite 400E, Washington, DC 20220 A ACTION REQUESTED - Please read instructions to check appropriate box 1. NEW USER PREPARER/REVIEWER B USER INFORMATION: 3. FIRST NAME MODIFY USER/ ADD PERMIT DELETE USER REACTIVATE USER 2. IF MODIFYING, DELETING, OR REACTIVATING THEN PROVIDE EXISTING USER ID, if known Please complete section B with all the required data to establish a user identification record. 4. MIDDLE 5. LAST NAME.

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