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Dbpr Form Abt-6009 - Division Of Alcoholic Beverages And Tobacco Change Of Business Name Or Change Of Mailing Address Application

DBPR ABT-6009 – Division of Alcoholic Beverages and Tobacco Change of Business Name or

Change of Mailing Address Application

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, Division of Alcoholic Beverages & Tobacco, at

(850) 488-8288. Please submit your completed application and required fees to:

Department of Business and Professional Regulation

Division of Alcoholic Beverages & Tobacco

1940 North Monroe Street

Tallahassee, FL 32399-1021

or you may apply online at:

https://

SECTION 1- CHECK TRANSACTION REQUESTED

Transaction Type:

Business Name Change

Mailing Address Change

SECTION 2- CHECK LICENSE/PERMIT TYPE

License Type:

Beverage License

Wholesale Tobacco License

Retail Tobacco Permit

SECTION 3 - CHANGE OF BUSINESS NAME

License/Permit Number

Licensee

Old Business Name

New Business Name

SECTION 4 - CHANGE OF MAILING ADDRESS

License/Permit Number

Licensee

New Mailing Address

City

State

Zip Code

SECTION 5 - APPLICANT SIGNATURE

APPLICANT SIGNATURE ________________________________________Date__________________

Dbpr Form Abt-6009 - Division Of Alcoholic Beverages And Tobacco Change Of Business Name Or Change Of Mailing Address Application