Dbpr Form Abt-6028 - Examination Application
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4DBPR ABT-6028 – Division of Alcoholic Beverages and Tobacco Application for Retail Tobacco Products
Dealer Permit
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL
REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-0783
NOTE – This form must be submitted as part of an
application packet
If you have any questions or need assistance in completing this application, please contact the Department of
Business and Professional Regulation or your local district office. Please submit your completed application and
required fee(s) to your local district office. This application may be submitted by mail, through appointment, or it
can be dropped off. A District Office Address and Contact Information Sheet can be found on AB&T’s page of
the DBPR web site at the link provided below.
SECTION 1 - CHECK TRANSACTION REQUESTED
Transaction Type:
New Permit
Change of Business Name
Change of Location
Change of Officers/Stockholders
SECTION 2 - CHECK TYPE OF APPLICANT
Individual
Corporation
Partnership
Charter Number:
Limited Partnership
SECTION 3 - CHECK TYPE OF SALES
Vending Machine Sales
Over the Counter Sales
Mobile
VIN #:
SECTION 4 - LICENSE INFORMATION
Current Retail Tobacco Products Dealer Permit #
Current Alcoholic Beverage License # (if applicable)
Full Name of Applicant (if this is a corporation or other legal entity, enter the name as registered with the
Secretary of State)
Business Name (D/B/A)
Location Address
City
County
State
Zip Code
Mailing Address
City
State
Zip Code
Business Telephone Number
FEIN Number
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