Division Of Alcoholic Beverages And Tobacco Quota License Drawing Entry Form
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2DBPR ABT-6033 – Division of Alcoholic Beverages and Tobacco
Quota License Drawing Entry Form
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-1021
For Division Use Only
A. ENTRY FORM FOR
COUNTY
B. LIST ALL INTERESTED PERSONS
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Attach additional page if necessary)
C. Corporation or Other
Legal Entity:
(List officers, stockholders, etc.,
(Name of Entity)
in Section B above)
D. Mailing Address:
(Include City, State, and Zip Code)
AFFIRMATION
"I affirm under penalty of perjury that the information on this entry form is true to the best of my knowledge, and that no
other person, persons, firm, corporation, or other legal entity except as listed above, will have an interest in any alcoholic
beverage license obtained as a result of this drawing. I also affirm that to the best of my knowledge, none of the above
named persons or entities have made any other entry into the drawing for the county indicated above."
Print or Type Name
Signature
Print or Type Name
Signature
Print or Type Name
Signature
(Attach additional page for signatures, if necessary)
abt-6033 Quota License Drawing Entry From.doc Effective 09/2008
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