Dbpr Form Abt-6022 - Examination Application printable pdf download

Dbpr Form Abt-6022 - Examination Application

DBPR ABT-6022 – Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in

Spirituous Alcoholic Beverage License

STATE OF FLORIDA

DEPARTMENT OF BUSINESS AND PROFESSIONAL

REGULATION

1940 North Monroe Street

Tallahassee, FL 32399-0783

If you have any questions or need assistance in completing this application, please contact the Department of

Business and Professional Regulation, at (850) 488-8288. Please send your completed application and required

fee(s) to:

Department of Business and Professional Regulation

1940 North Monroe Street

Tallahassee, FL 32399-1021

SECTION 1 - CHECK TRANSACTION REQUESTED

Transaction Type:

Lien Recordings (New Lien)

Lien Assignment/Assumption

Lien Renewal/Extension

SECTION 2 – DEBTOR(S) INFORMATION

Full Name of Debtor

Mailing Address

City

State

Zip Code

Full Name of Debtor (if more than one)

Mailing Address

SECTION 3 – SECURED PARTY(S) INFORMATION

Full Name of Secured Party

Mailing Address

City

State

Zip Code

Full Name of Secured Party (if more than one)

Mailing Address

City

State

Zip Code

SECTION 4 – EFFECTIVE DATE OF SECURITY INTEREST

(Month/Day/Year)

SECTION 5 – ALCOHOLIC BEVERAGE LICENSE NUMBER

This section is for reference purposes only. Alcoholic Beverage License must be specifically pledged, by number,

as collateral in the Security Agreement.

License Number

Dbpr Form Abt-6022 - Examination Application