DBPR ABT-6002, Division of Alcoholic Beverages and Tobacco Application for Transfer of Ownership of an Alcoholic Beverage License Instructions

Enter the sequential identifier or record number for this related-party entry (e.g., 1, 2) to distinguish multiple entries.

Enter the business's trade name or "doing business as" (D/B/A) name associated with this related party.

Enter the individual's full legal name (first, middle, last) as it appears on official documents.

Provide the individual's Social Security Number, including any dashes or spaces used in your usual formatting.

Enter the individual's primary home telephone number including area code and any punctuation or country code as needed.

Enter the individual's date of birth.

Enter whether the person is a U.S. citizen by typing 'Yes' or 'No'.

If the person answered 'No', enter their immigration card number or passport number exactly as shown on the document; leave blank if the person is a U.S. citizen. Fill only if '3. Are you a U.S. citizen? — No' is 'Yes'.

Check this box if the person named in this section is a U.S. citizen.

Check this box if the person named in this section is not a U.S. citizen (if checked, provide the immigration card number or passport number in the field below).

Enter your home street address including house number and any apartment or unit number (e.g., 123 Main St Apt 4B).

Enter the city of your home address (e.g., Anytown).

Enter the state for your home address, either the two-letter abbreviation or the full state name (e.g., CA or California).

Enter the postal ZIP code for your home address (five digits or ZIP+4, e.g., 12345 or 12345-6789).

Check this box if you currently own or have any financial or managerial interest in a business that sells alcoholic beverages, wholesale cigarette or tobacco products, or operates as a bottle club.

Check this box if you do not currently own and do not have any financial or managerial interest in a business that sells alcoholic beverages, wholesale cigarette or tobacco products, or operates as a bottle club.

Enter the trade name or 'doing business as' (D/B/A) name of the alcoholic beverage, tobacco, or bottle club business you currently own or have an interest in. Fill only if '5. Do you currently own or have an interest in any alcohol/tobacco business? — Yes' is 'Yes'.

Enter the business’s alcohol, tobacco, or bottle club license or permit number as issued by the licensing authority. Fill only if '5. Do you currently own or have an interest in any alcohol/tobacco business? — Yes' is 'Yes'.

Enter the street location of the business, including city and state, where the alcoholic beverage, tobacco, or bottle club activity takes place. Fill only if '5. Do you currently own or have an interest in any alcohol/tobacco business? — Yes' is 'Yes'.

Enter the sequential number shown in the left margin that identifies which related person this section applies to.

Check this box if you have had any type of alcoholic beverage, bottle club license, or cigarette/tobacco permit refused, revoked, or suspended anywhere in the past 15 years.

Check this box if you have not had any type of alcoholic beverage, bottle club license, or cigarette/tobacco permit refused, revoked, or suspended anywhere in the past 15 years.

Enter the trade name (doing business as) of the business whose alcoholic beverage, bottle club, cigarette or tobacco license or permit was refused, revoked, or suspended. Fill only if '6. Yes' is 'Yes'.

Enter the date when the license or permit was refused, revoked, or suspended. Fill only if '6. Yes' is 'Yes'.

Enter the full street address of the business location related to the refused/revoked/suspended license or permit, including city and state. Fill only if '6. Yes' is 'Yes'.

Check this box if you have been convicted of a felony at any time within the past 15 years.

Check this box if you have not been convicted of a felony at any time within the past 15 years.

Enter the date when the felony conviction occurred within the past 15 years. Fill only if '7. Have you been convicted of a felony within the past 15 years? — Yes' is 'Yes'.

Enter the location (city, state, or jurisdiction) where the felony conviction took place. Fill only if '7. Have you been convicted of a felony within the past 15 years? — Yes' is 'Yes'.

Enter the specific felony offense(s) for which you were convicted. Fill only if '7. Have you been convicted of a felony within the past 15 years? — Yes' is 'Yes'.

Check this box if you have been convicted of an offense involving alcoholic beverages or tobacco products anywhere within the past 5 years.

Check this box if you have NOT been convicted of an offense involving alcoholic beverages or tobacco products anywhere within the past 5 years.

Enter the date the offense or conviction involving alcoholic beverages or tobacco products occurred within the past five years. Fill only if '8. Offense Involving Alcohol/Tobacco - Yes' is 'Yes'.

Provide the location where the offense or conviction took place (city and state and any additional location details). Fill only if '8. Offense Involving Alcohol/Tobacco - Yes' is 'Yes'.

Describe the specific offense, charge, or conduct involving alcoholic beverages or tobacco products, including any pertinent details. Fill only if '8. Offense Involving Alcohol/Tobacco - Yes' is 'Yes'.

Enter the date the ABT district office received this application/document.

Enter the name of the state where the affidavit is being sworn or executed (e.g., Florida).

Enter the name of the county in which the affidavit is being sworn or executed (e.g., Miami‑Dade).

Enter the full name of the U.S. state where the affidavit is being executed (the 'State of' venue). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the full name of the county where the affidavit is being executed (the 'County of' venue). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the applicant's Federal Employer Identification Number (FEIN) as registered with the Florida Department of State.

Enter the primary business telephone number for the applicant, including area code and extension if applicable.

Enter a contact email address for the business; this field is optional.

Enter the full legal name of the applicant(s) exactly as it should appear on the license.

Enter the document number issued by the Florida Department of State Division of Corporations for this entity.

Enter the business trade name or 'doing business as' (DBA) name if the business operates under a name different from the legal applicant name.

Enter the applicant's full legal name exactly as the license should be issued (first, middle, last or business name as appropriate).

Enter the business name or 'doing business as' (DBA) name associated with this application.

Enter the full street address of the business location, including apartment, suite, or unit number if applicable.

Enter the city in which the business or applicant's address is located.

Enter the county where the business location or applicant address is situated.

Enter the postal ZIP code for the business address (include ZIP+4 if available).

Enter the full name of the applicant or the authorized representative who is signing the affidavit.

Enter the name of the person or business entity authorized to receive the Department of Revenue account status information. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the Department of Revenue account number whose status you authorize to be released. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the full name of the Bar Manager for fraternal organizations of national scope associated with this business.

Enter the business's trade name or 'doing business as' name exactly as it appears on official records. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the quota license number associated with this business as assigned by the Department of Business and Professional Regulation. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the date on which the seller originally obtained the quota license. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the business location's street address, including street number and name (e.g., 123 Main St).

Enter the city where the business location is physically situated.

Enter the county in which the business location is located.

Enter the two-letter state abbreviation for the business location (for example, FL).

Enter the postal ZIP code for the business location (typically five digits).

Enter the business's mailing street address or P.O. Box, including apartment, suite, or unit number if applicable.

Enter the city name for the business mailing address.

Enter the state for the business mailing address (use the two‑letter state abbreviation, e.g., FL).

Enter the ZIP code for the business mailing address (5‑digit or ZIP+4 format, e.g., 12345 or 12345-6789).

Enter the full business name or the trade name (Doing Business As) under which the licensed premises operate.

Enter the business’s legal name and/or the trade name (doing business as) under which the business operates.

Enter the business's trade name or 'doing business as' name exactly as it should appear on the license or application.

Enter the business's trade name or 'doing business as' (D/B/A) name for the entity whose license is being transferred; include the name exactly as it should appear on the license. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the business's trade name or 'doing business as' (DBA) name exactly as it should appear on the license, including any punctuation or suffixes.

Enter the business's Doing Business As (D/B/A) name exactly as it should appear for the transfer of ownership application. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the full name of the contact person for this application (first and last name; include a title if desired).

Enter the contact person's primary telephone number, including area code and any punctuation or spaces as needed (e.g., 555-123-4567).

Enter the contact person's telephone extension number if applicable, or leave blank if none.

Enter the contact person's email address for correspondence, or leave blank if you do not wish to provide one.

Enter the contact person's mailing address (street address or P.O. Box).

Enter the city for the contact person's mailing address.

Enter the state for the contact person's mailing address (use the two-letter abbreviation or full state name).

Enter the postal ZIP code for the contact person's mailing address.

Enter the officer's or director's job title or position (for example, President, Treasurer, Secretary) for the first listed corporate officer, director, or stockholder.

Enter the full legal name of the first corporate officer, director, or stockholder as it should appear on the record.

Enter the percentage of corporate stock owned by the first listed person.

Provide the job title or position held by the fourth officer, director, or stockholder (for example, President, Secretary, Director).

Enter the full legal name of the fourth officer, director, or stockholder associated with this corporate listing.

Enter the percentage of the corporation's stock owned by this individual.

Enter the officer’s, director’s, or stockholder’s job title or position within the corporation (e.g., President, Secretary, Director).

Enter the full legal name of the officer, director, or stockholder associated with this entry.

Enter the percentage of corporate stock owned by this person.

Enter the officer, director, or stockholder’s job title or position (e.g., President, Secretary) for the third listed corporate person.

Enter the full legal name of the third officer, director, or stockholder as it should appear on the record.

Enter the percentage of company stock owned by the third listed person.

Enter the fifth licensee's last (family) name.

Enter the fifth licensee's current alcohol beverage and/or tobacco license permit number(s) exactly as shown on the license.

Enter the fifth licensee's date of birth.

Enter the fifth licensee's Social Security Number (SSN).

Enter the fifth licensee's street address, including apartment or suite number if applicable.

Enter the city for the fifth licensee's street address.

Enter the two-letter state abbreviation for the fifth licensee's address.

Enter the ZIP Code for the fifth licensee's address.

Enter the licensee's full name showing last name first, then first name and middle initial if applicable.

Enter all current alcohol beverage and/or tobacco license permit number(s) held by this licensee, separated by commas if more than one.

Enter the licensee's date of birth.

Enter the licensee's Social Security Number (SSN).

Enter the licensee's street mailing address, including apartment or suite number if applicable.

Enter the city for the licensee's street address.

Enter the state for the licensee's address (use the two-letter abbreviation or full state name).

Enter the ZIP code for the licensee's street address.

Enter the fourth licensee's family or surname exactly as it appears on legal documents.

Enter the current alcohol beverage and/or tobacco license permit number(s) assigned to the fourth licensee; include multiple numbers separated by commas if applicable.

Provide the fourth licensee's date of birth.

Enter the fourth licensee's Social Security Number (SSN) as a continuous value, including any leading zeros if applicable.

Enter the fourth licensee's street address, including house number, street name, and apartment or unit number if applicable.

Enter the city for the fourth licensee's mailing or residential address.

Enter the state for the fourth licensee's address (typically the two-letter state abbreviation).

Enter the ZIP or postal code for the fourth licensee's address.

Enter the job title or position held by the first general partner within the partnership (for example: Partner, Managing Partner, President).

Enter the full legal name of the first general partner as it should appear on official records.

Enter the percentage of ownership or stock held by the first general partner in the partnership.

Enter the job title, role, or position held by the fourth general partner within the partnership (e.g., Partner, Managing Partner).

Enter the full legal name of the fourth general partner (first name, middle initial if used, and last name).

Enter the ownership percentage or stock interest held by the fourth general partner in the entity.

Enter the job title or position held by the second general partner (for example: Partner, Managing Partner, President).

Enter the full legal name of the second general partner (first and last name or business name as applicable).

Enter the percentage of ownership held by the second general partner in the partnership.

Enter the job title or position held by the third general partner within the partnership (e.g., Partner, Managing Partner).

Enter the full legal name of the third general partner (first name, middle initial if any, and last name).

Enter the percentage of partnership ownership or stock held by the third general partner as a numeric value.

Enter the full name of the health authority representative who signed to certify the establishment complies with the Florida Sanitary Code.

Enter the date the health authority representative signed this compliance approval.

Enter the job title or position of the person who signed the approval (for example, Environmental Health Director).

Enter the name of the issuing agency, county health authority, or department that granted the sanitary code approval.

Enter the type and/or details of the identification that the person produced (for example, 'Driver's License #DL123456', 'Passport #123456789', or similar identifying document). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the sequential item number for this related-person entry as shown on the left side of the form (for example, '1').

Enter the individual's race or ethnicity (for example, 'White', 'Black or African American', 'Asian', 'Hispanic', etc.).

Enter the individual's sex or gender identifier (for example, 'M' or 'Male', 'F' or 'Female', or another descriptor).

Enter the individual's height (use a clear format such as '5 ft 10 in' or '178 cm').

Enter the individual's weight (include units if desired, for example '180 lb' or '82 kg').

Enter the individual's eye color (for example, 'Brown', 'Blue', 'Hazel', 'Green').

Enter the individual's hair color or description (for example, 'Black', 'Brown', 'Blond', 'Gray', or 'Bald').

Enter the job title or position held by the first interested party (for example: Officer, Director, President, Treasurer, or other role) as it should appear on the disclosure.

Provide the license series identifier or code you are requesting (for example, a series number or series code).

Enter the license type or class you are requesting (for example, the type name or class code).

Indicate whether a child license is being requested by entering 'Yes' or 'No', or provide the specific child license identifier if applicable.

Enter the total number of child licenses you are requesting using numerals. Fill only if 'Child License Requested' is 'Yes'.

Check this box if the transaction involves a Retail Alcoholic Beverages license.

Check this box if the transaction involves an Alcoholic Beverage Broker Sales Agent license.

Check this box if the transaction involves a Beer/Wine/Liquor Wholesaler license.

Check this box if the transaction involves an Alcoholic Beverage Manufacturer license.

Check this box if the transaction involves an Alcoholic Beverage Importer license.

Check this box if the transaction involves a Passenger Waiting Lounge license.

Enter the percentage of ownership (stock %) held by the listed limited liability company manager, director, officer, or member for this row.

Enter the job title or position of the first manager or member (for example: Manager, Member, Director, Officer).

Enter the full name (first and last) of the first manager or member of the limited liability company.

Enter the percentage of stock or ownership interest held by the first manager or member.

Enter the job title or position held by the second listed manager or member (for example, Manager, Member, Director, Officer).

Enter the full legal name of the second listed manager or member (first and last name or business name as applicable).

Enter the ownership or stock percentage held by the second listed manager or member as a numeric value (include decimals if needed).

Enter the job title or official position held by the third manager or member of the limited liability company (e.g., Manager, Member, Director).

Enter the full name of the third manager or member of the limited liability company as it should appear on the application.

Enter the percentage of ownership, stock, or membership interest held by the third manager or member.

Enter the percentage of stock ownership held by the Limited Liability Partnership partner listed on the same row.

Enter the partner's title or position within the limited liability partnership (for example: Partner, Managing Partner, Member, Manager).

Enter the full legal name of the first limited liability partnership partner as it should appear on official records.

Enter the percentage of ownership or stock interest held by the first partner in the partnership.

Enter the partner's job title or position within the partnership (for example, Partner, Managing Partner, Bar Manager, etc.).

Enter the full legal name of the second limited liability partner listed for this business.

Enter the percentage ownership or stock interest held by the second partner in the business.

Enter the first partner's role or title within the limited partnership (for example: General Partner, Limited Partner, Managing Partner).

Enter the full legal name of the first partner (first name and last name; include middle initial if required).

Enter the percentage of partnership interest or stock owned by the first partner.

Enter the partner's role in the limited partnership (for example, General Partner or Limited Partner).

Enter the full legal name of the second partner (first name and last name).

Enter the percentage of ownership or stock held by the second partner in the entity.

Check this box to indicate the application includes new retail tobacco products (you must also select one or more specific product options below).

Check this box if the new retail tobacco products being requested are pipes only.

Check this box if the new retail tobacco products will be sold over the counter (directly to customers at the point of sale).

Check this box if the new retail tobacco products will be sold via vending machines.

Enter the full printed name of the notary public (as to appear on the notarization/signature block).

Enter the expiration date of the notary public's commission.

Enter the name of the U.S. state where the notarization is taking place.

Enter the name of the county where the notarization is taking place.

Enter the day of the month on which the notarization was performed (the numeric day of the month).

Enter the month in which the notarization was performed (e.g., the month name or abbreviation).

Enter the year in which the notarization occurred.

Enter the full printed name of the person who made or signed the statement before the notary (the declarant).

Enter the identification shown to the notary or a brief description of the ID used to verify the signer’s identity.

Enter the day of the month or day descriptor on which the acknowledgment was taken (the word/number that completes 'Before me this ___ Day'). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the month in which the acknowledgment was taken (e.g., January, Feb., etc.). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the year in which the acknowledgment was taken. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the full printed name or names of the person(s) who appeared and made the statement (the name following 'By'). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the type and any identifying information of the identification presented to the notary (for example, driver’s license, passport, and number or other description). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the day of the month on which the notary acknowledgment was performed. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the month when the notary acknowledgment took place (e.g., the month name or abbreviation). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the year in which the notary acknowledgment occurred. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the day of the month on which the notarial acknowledgment occurred (numeric day, e.g., 5 or 21).

Enter the month in which the notarial acknowledgment occurred (spell out the month name or use a standard abbreviation, e.g., March or Mar).

Enter the year in which the notarial acknowledgment occurred (preferably four digits, e.g., 2026).

Enter the printed full name(s) of the person or persons who appeared before the notary and made the statement.

Enter the identification the appearing person produced, including type and any identifying number or issuing authority (e.g., Driver's License No. 123456, State).

Enter the name or official postal abbreviation of the state where the notarization/acknowledgment took place. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the name of the county in which the notarization/acknowledgment was performed. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the expiration date of the notary public's commission as shown on the notary certificate. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the full signature of the notary public who administered the oath or acknowledgment for this document. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the notary public's handwritten signature as it should appear on the affidavit.

Enter the expiration date of the notary public's commission.

Enter the notary public's signature or printed name to acknowledge and sign the affidavit. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the expiration date of the notary public's commission. Fill only if 'Transfer of Ownership' is 'Yes'.

Check this box if there are persons or entities not disclosed elsewhere who HAVE loaned money to the business.

Check this box if there are no persons or entities not disclosed elsewhere who have loaned money to the business.

Check this box if there are any persons or entities not disclosed that derive revenue from the license solely through a contractual relationship with the licensee (the substance of which is not related to control of the sale of alcoholic beverages or is exempt by statute or rule).

Check this box if there are no persons or entities not disclosed that derive revenue from the license solely through a contractual relationship with the licensee as described in the question.

Check this box if there are any persons or entities not disclosed that have the right to receive revenue based on a contractual relationship related to the control of the sale of alcoholic beverages.

Check this box if there are no persons or entities not disclosed who have the right to receive revenue based on a contractual relationship related to the control of the sale of alcoholic beverages.

Check this box if there are persons or entities not already disclosed who have a right to receive a percentage payment from the business proceeds under the lease.

Check this box if there are no persons or entities not already disclosed who have a right to receive a percentage payment from the business proceeds under the lease.

Check this box if there are any persons or entities not disclosed on this application who have guaranteed the lease or loan for the business.

Check this box if there are any persons or entities not disclosed on the application who have co-signed the lease or loan for this business.

Check this box if there are no persons or entities not disclosed on the application who have co-signed the lease or loan for this business.

Check this box if there is a management contract, franchise agreement, or concession agreement in connection with this business.

Check this box if there is no management contract, franchise agreement, or concession agreement in connection with this business.

Check this box if you or anyone listed on this application accepted money, equipment, or anything of value in connection with this business from any industry member as described in 61A-1.010, Florida Administrative Code.

Check this box if you and everyone listed on this application did NOT accept money, equipment, or anything of value in connection with this business from any industry member as described in 61A-1.010, Florida Administrative Code.

Enter the full printed name or names of the person(s) who are making the statement, as they should appear in the notarized acknowledgment. Fill only if 'Transfer of Ownership' is 'Yes'.

Check this box if there is any personal relationship between the applicant and the transferor.

Check this box if there is no personal relationship between the applicant and the transferor.

If you answered Yes to having a personal relationship with the transferor, briefly describe the nature of that relationship (for example: familial, business partner, spouse, etc.), including any relevant names or details needed to clarify the connection. Fill only if 'Personal relationship to transferor — Yes' is 'Yes'.

Provide a detailed floor plan or written description of the premises showing walls, doors, counters, sales areas, storage areas, restrooms, bar locations, sidewalks or other contiguous outside areas and any other specific areas to be licensed; include details for each floor if the building is multi‑story.

Enter the full legal name of the purchaser or authorized individual responsible for the purchase. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the purchaser's business name or Doing Business As (D/B/A) name, if applicable; leave blank if none. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the purchaser's state sales tax or reseller permit number issued by the Department of Revenue. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the purchaser's street address for the business or primary location, including number, street name, and suite/unit if applicable. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the city of the purchaser's street address. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the two-letter state abbreviation for the purchaser's address (e.g., FL). Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the purchaser's ZIP code or postal code for the street address. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the date when the purchaser (owner, partner, or principal of the legal entity) signed this form. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the applicant's answer to whether the proposed premises are movable or able to be moved (for example: "Yes" or "No").

Check this box if the proposed premises are movable or able to be moved.

Check this box if the proposed premises are not movable and cannot be moved.

If the premises are movable, provide brief explanatory details about the movability or how the premises can be moved; if not, leave blank or enter 'N/A'.

Enter the applicant's short response for Question 10 indicating whether they meet the standards of the moral character rule (e.g., 'Yes' or 'No' or an abbreviated marker).

Enter the marker placed in the 'Yes' box for Question 10 to indicate the applicant affirms they meet the standards of the moral character rule (e.g., 'X' or 'Yes').

Enter the marker placed in the 'No' box for Question 10 to indicate the applicant does not meet the standards of the moral character rule (e.g., 'X' or 'No').

Enter 'Yes' or 'No' to indicate whether you are an officer or employee of the Division of Alcoholic Beverages and Tobacco or a sheriff or other state, county, or municipal officer (including reserve or auxiliary) with current and active arrest certification; if 'Yes', also provide your agency name and current certification status.

Check this box if you are an officer or employee of the Division of Alcoholic Beverages and Tobacco, or a sheriff or other state, county, or municipal officer (including reserve or auxiliary) who is certified by the state with current and active arrest powers.

Check this box if you are not an officer or employee of the Division of Alcoholic Beverages and Tobacco and are not a sheriff or other state, county, or municipal officer (including reserve or auxiliary) certified by the state with current and active arrest powers.

Enter 'Yes' if there is access through the premises to any area over which you do not have dominion and control; otherwise leave blank.

Check this box if there is access through the licensed premises to any area over which you do not have dominion and control.

Check this box if there is no access through the licensed premises to any area over which you do not have dominion and control.

Enter 'No' if there is not access through the premises to any area over which you do not have dominion and control; otherwise leave blank.

Enter whether the business is located within a Specialty Center by typing the answer (for example: "Yes" or "No").

Check this box if the business IS located within a Specialty Center.

Check this box if the business is NOT located within a Specialty Center.

If the business is located within a Specialty Center, specify the applicable statute or citation (for example: "561.20(2)(b)1, F.S." or "561.20(2)(b)2, F.S."); leave blank if not applicable.

If you checked Yes for Question 3, check this box when the Specialty Center location is governed by statute 561.20(2)(b)1, F.S. Fill only if 'Question 3 (1) - Located in a Specialty Center (Answer)' is 'Yes'.

If you checked Yes for Question 3, check this box when the Specialty Center location is governed by statute 561.20(2)(b)2, F.S. Fill only if 'Question 3 (1) - Located in a Specialty Center (Answer)' is 'Yes'.

Type 'Yes' if there are any mobile vehicles used to sell or serve alcoholic beverages for this business; otherwise leave blank or enter 'No' in the corresponding field.

Check this box if there are one or more mobile vehicles used to sell or serve alcoholic beverages associated with the proposed premises.

Check this box if there are no mobile vehicles used to sell or serve alcoholic beverages associated with the proposed premises.

Type 'No' if there are no mobile vehicles used to sell or serve alcoholic beverages for this business; otherwise leave blank or enter 'Yes' in the corresponding field.

Enter 'Yes' (or place the character used on this form) to indicate that there are more than three separate rooms or enclosures with permanent bars or counters on the premises.

Check this box if there are more than three separate rooms or enclosures on the premises that have permanent bars or counters.

Check this box if there are not more than three separate rooms or enclosures on the premises that have permanent bars or counters.

Enter 'No' (or place the character used on this form) to indicate that there are not more than three separate rooms or enclosures with permanent bars or counters on the premises.

Check this box if you have been arrested or issued a notice to appear in any U.S. state or territory within the past 15 years.

Check this box if you have not been arrested or issued a notice to appear in any U.S. state or territory within the past 15 years.

Enter the date when the arrest or notice to appear occurred. Fill only if 'Question 9 - Yes' is 'Yes'.

Provide the location where the arrest or notice to appear occurred (city and state, and county or jurisdiction if known). Fill only if 'Question 9 - Yes' is 'Yes'.

Enter the name or brief description of the offense or charge for which you were arrested or issued a notice to appear. Fill only if 'Question 9 - Yes' is 'Yes'.

Enter the calendar year for the seller's first year of sales shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the seller during the first year listed in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the seller's second year of sales shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the seller during the second year listed in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the seller's third year of sales shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the seller during the third year listed in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year that corresponds to the first year of sales for row 10 (for example, 2023). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the first year associated with row 10. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year that corresponds to the second year of sales for row 10. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the second year associated with row 10. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year that corresponds to the third year of sales for row 10. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the third year associated with row 10. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the four-digit calendar year for the first year of sales (e.g., 2020). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount in US dollars for the first year shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the four-digit calendar year for the second year of sales (e.g., 2021). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount in US dollars for the second year shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the four-digit calendar year for the third year of sales (e.g., 2022). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount in US dollars for the third year shown in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the seller's first reporting year in this row (for example, 2023). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's total sales amount for the first year shown on this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the seller's second reporting year in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's total sales amount for the second year shown on this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the seller's third reporting year in this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's total sales amount for the third year shown on this row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the first reporting year for this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the first year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the second reporting year for this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the second year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the third reporting year for this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the third year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the first year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the first year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the second year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the second year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the third year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the third year in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the first year in the sales history on row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the amount of sales for the first year on sales history row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the second year in the sales history on row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the amount of sales for the second year on sales history row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the calendar year for the third year in the sales history on row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the amount of sales for the third year on sales history row 4. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the first year for Sales History Row 5 that corresponds to the first-year sales shown on this line. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the first year in Sales History Row 5. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the second year for Sales History Row 5 that corresponds to the second-year sales shown on this line. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the second year in Sales History Row 5. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the third year for Sales History Row 5 that corresponds to the third-year sales shown on this line. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales amount for the third year in Sales History Row 5. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's first year of sales for row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total amount of sales for the seller during the first year on row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's second year of sales for row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total amount of sales for the seller during the second year on row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the seller's third year of sales for row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total amount of sales for the seller during the third year on row 6. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the first of the three years being reported for this sales history row (the calendar or license year for the first-year sales). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total dollar amount of sales for the first year listed in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the second of the three years being reported for this sales history row (the calendar or license year for the second-year sales). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total dollar amount of sales for the second year listed in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the third of the three years being reported for this sales history row (the calendar or license year for the third-year sales). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total dollar amount of sales for the third year listed in this sales history row. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the first year of the seller's three-year sales history for row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the first year corresponding to row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the second year of the seller's three-year sales history for row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the second year corresponding to row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the third year of the seller's three-year sales history for row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sales amount for the third year corresponding to row 8. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The calendar year for the FIRST YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The total sales amount for the FIRST YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The calendar year for the SECOND YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The total sales amount for the SECOND YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The calendar year for the THIRD YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

The total sales amount for the THIRD YEAR column on sales history Row 9. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Full name and/or signature of the Department of Revenue official certifying that the applicant has complied with sales and use tax requirements. Fill only if 'Transfer of Ownership' is 'Yes'.

The date the Department of Revenue official signed and approved the sales tax compliance. Fill only if 'Transfer of Ownership' is 'Yes'.

Job title or official position of the Department of Revenue official who signed the approval. Fill only if 'Transfer of Ownership' is 'Yes'.

Number of days the Department of Revenue's sales tax approval is valid from the date of signature. Fill only if 'Transfer of Ownership' is 'Yes'.

Enter the second licensee's last name (surname) as it appears on legal documents.

Provide all current alcohol beverage and/or tobacco license permit number(s) held by the second licensee, separated by commas if more than one.

Enter the second licensee's date of birth.

Enter the second licensee's Social Security Number (SSN), including dashes if required.

Enter the street address (number, street name, apartment or suite if applicable) for the second licensee's residence or mailing address.

Enter the city for the second licensee's address.

Enter the U.S. state for the second licensee's address (use the two-letter postal abbreviation or full state name).

Enter the ZIP code for the second licensee's address (5-digit or 9-digit ZIP+4).

Enter the applicant entity's business name or doing-business-as (D/B/A) name exactly as it should appear on the application.

Check this box if the applicant entity has been convicted of a felony in this state, any other state, or by the United States within the last 15 years.

Check this box if the applicant entity has not been convicted of a felony in this state, any other state, or by the United States within the last 15 years.

If the entity has been convicted of a felony in the last 15 years, provide all details including date(s) of conviction, the crime(s) charged, and the city, county, state and court where each conviction occurred. Fill only if 'Section 6 - Applicant entity convicted of a felony: Yes' is 'Yes'.

Enter the applicant's initials to acknowledge the statements in Section 7. Fill only if 'License Series Requested' is not a Beer and Wine license.

Enter the date when the applicant provided the initials for Section 7. Fill only if 'License Series Requested' is not a Beer and Wine license.

Enter the business's trade name or "doing business as" (D/B/A) name exactly as it should appear on the license or application. Fill only if 'License Series Requested' is not a Beer and Wine license.

Check this box if you are applying for a Quota Alcoholic Beverage License (the license type subject to quota restrictions). Fill only if 'License Series Requested' is not a Beer and Wine license.

Check this box if you are applying for a Special Alcoholic Beverage License (the special category license described on this form). Fill only if 'License Series Requested' is not a Beer and Wine license.

Check this box if you are applying for a Club Alcoholic Beverage License (the license issued to clubs meeting the statutory club requirements). Fill only if 'License Series Requested' is not a Beer and Wine license.

Enter the Florida Statute section number or Special Act citation that authorizes this special alcoholic beverage license (e.g., the statute or act number referenced on the license). Fill only if 'Quota Alcoholic Beverage License', 'Special Alcoholic Beverage License', 'Club Alcoholic Beverage License' is 'Yes' for any fields selection.

Enter the full details describing the special license requirements being claimed or met (including the statute or special act citation, specific conditions, limitations, locations, dates, and any other relevant facts); if more space is needed, indicate additional sheets are attached. Fill only if 'Quota Alcoholic Beverage License', 'Special Alcoholic Beverage License', 'Club Alcoholic Beverage License' is 'Yes' for any fields selection.

Enter the seller's full legal business name as it appears on official records or the current alcohol license.

Enter the seller's current alcoholic beverage license number issued by the state or licensing authority.

Enter the full legal name of the seller/transferor (individual, partner, or business/legal entity) exactly as it appears on licensing or legal documents. Fill only if 'Transfer of Ownership' is 'Yes'.

Check this box if you wish to purchase a temporary license.

Check this box if you do not wish to purchase a temporary license.

Enter the last name (surname) of the third licensee as it should appear on official records.

Enter the current alcoholic beverage and/or tobacco license or permit number(s) associated with the third licensee; include multiple numbers separated by commas if applicable.

Provide the date of birth of the third licensee.

Enter the Social Security Number for the third licensee exactly as issued.

Enter the street address for the third licensee, including apartment or unit number if applicable.

Enter the city for the third licensee's street address.

Enter the state for the third licensee's address (use the standard two-letter abbreviation or full state name as required).

Enter the ZIP or postal code for the third licensee's address, including any leading zeros.

Check this box if you are applying to transfer ownership of the alcoholic beverage license to a new owner.

Check this box if the licensed business is changing its physical location.

Check this box if the legal or trade name on the license will be changed.

Check this box if you are requesting a change to the license series or classification.

Check this box if you are requesting a decrease in the number or level of license series.

Check this box if you are requesting an increase in the number or level of license series.

Check this box if there is a change in corporate officers or stockholders, or if the corporate name on the license is being amended.

Check this box if the transfer of this license is due to revocation proceedings (answering 'Yes' to that question).

Check this box if the transfer of this license is not due to revocation proceedings (answering 'No' to that question).

Enter the total sales for the first year to be used in the transfer fee computation. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales for the second year to be used in the transfer fee computation. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the total sales for the third year to be used in the transfer fee computation. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the sum of the first, second, and third year totals (the three-year total). Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the result of dividing the three-year total by 3 to obtain the average annual sales. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the transfer fee calculated from the average annual sales multiplied by the applicable rate. Fill only if 'Quota Alcoholic Beverage License' is 'Yes'.

Enter the license series number referenced by the zoning authority that the location complies with for the sale of alcoholic beverages. Fill only if 'Change of Location' is 'Yes'.

Check this box when the zoning approval includes outside areas contiguous to the licensed premises and those areas are identified on the sketch. Fill only if 'Change of Location' is 'Yes'.

Check this box when the zoning approval does not include any outside areas contiguous to the licensed premises. Fill only if 'Change of Location' is 'Yes'.

Check this box when the business location is inside the city limits (used to determine license fee sharing). Fill only if 'Change of Location' is 'Yes'.

Check this box when the business location is in the unincorporated county rather than inside city limits (used to determine license fee sharing). Fill only if 'Change of Location' is 'Yes'.

Enter the name or signature of the zoning authority official who signed to approve the location. Fill only if 'Change of Location' is 'Yes'.

Enter the date on which the zoning authority official signed the approval. Fill only if 'Change of Location' is 'Yes'.

Enter the job title or official position of the person who signed the zoning approval. Fill only if 'Change of Location' is 'Yes'.

Enter the number of days this zoning approval is valid. Fill only if 'Change of Location' is 'Yes'.