Dbpr Form Abt-6012 - Examination Application (Page 3 of 3) in pdf

Dbpr Form Abt-6012 - Examination Application Page 3

SECTION 5 - AFFIDAVIT OF APPLICANT

NOTARIZATION REQUIRED

Trade Name (D/B/A)

“I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby agree that by

acceptance of a permit, the place of business may be inspected and searched during business hours or at

any time business is being conducted on the vessel without a search warrant by officers of the Division of

Alcoholic Beverages and Tobacco, the Sheriff, his deputies and police officers for purposes of determining

compliance with the beverage law.

I, or we, understand that any permit issued under this application authorizes the sale of alcoholic

beverages for consumption on board the vessel only, during a period not in excess of 24 hours prior to

departure while the vessel is moored at docks or wharfs in ports of this state; or at any time while the

vessel is located in the Florida territorial waters and is in transit to or from international waters.

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

837.06, Florida Statutes, that the foregoing information is true and that no other person(s), firm, or

corporation, except as indicated herein, has an interest in the alcoholic beverage permit for which these

statements are made.”

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-6012 - Examination Application Page 3