Dbpr Form Abt-6033 - Examination Application (Page 2 of 2) in pdf

Dbpr Form Abt-6033 - Examination Application Page 2

SECTION 2 - AFFIDAVIT OF APPLICANT AND ALL PERSONS LISTED

NOTARIZATION REQUIRED

Applicant Name

“I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and

837.06, Florida Statutes, that the foregoing information is true to the best of my knowledge, and that no

other person, firm or corporation except as indicated herein, has an interest in the alcoholic beverage

license for which these statements are made. I also swear that to the best of my knowledge, none of the

above named persons or entities have any direct or indirect interest, either individually or with any other

applicant, in any other application for a new quota alcoholic beverage license in the county for which this

application is filed.

STATE OF___________________

_________________________________________________

APPLICANT SIGNATURE

COUNTY OF_________________

_________________________________________________

APPLICANT SIGNATURE

The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this __________Day

of______________, 20_____, By ___________________________________ who is ( ) personally

known to me OR ( ) who produced _____________________________________as identification.

________________________________________________ Commission Expires: ___________________

Notary Public

Dbpr Form Abt-6033 - Examination Application Page 2