Dbpr Form Abt-6012 - Examination Application printable pdf download

Dbpr Form Abt-6012 - Examination Application

DBPR ABT-6012 – Division of Alcoholic Beverages and Tobacco Application for Passenger Vessel

Permit

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 to:

Department of Business and Professional Regulation

1940 North Monroe Street

Tallahassee, FL 32399-1021

SECTION 1 - APPLICATION INFORMATION

Full Name of Applicant

Mailing Address

City

State

Zip Code

Contact Person

Department

Phone Number

Is this applicant a corporation or other legal entity?

Yes

If yes, the corporation or entity must be registered with the Florida Division of Corporations to conduct

business in Florida.

Corporate Document Number:

SECTION 2 - PASSENGER VESSEL INFORMATION

Name of Vessel

Name of Florida Port

City

County

As operator or concessionaire, we certify this passenger vessel cabin-berth capacity is for at least

[___________] passengers and that it is engaged exclusively in foreign commerce.

Dbpr Form Abt-6012 - Examination Application