Dbpr Form Ab&t - Certificate Of Breakage And/or Spoilage Of Alcoholic Beverages

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-034
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 10/04
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
CERTIFICATE OF BREAKAGE AND/OR SPOILAGE
OF ALCOHOLIC BEVERAGES
Name
Date
Address
City
FL
Zip Code
License Number: (K)LD
(J)DBW
BEER
Pints
Quarts
Bulk
or Less
32 Oz.
Gallons
We certify the above breakage/spoilage to be correct to the best of our knowledge and belief.
Licensee's Representative
Division's Representative
I,
the undersigned, who is duly authorized as a
representative of this licensee, further certify it is understood and agreed the beverages reflected above are in full compliance
with Florida Alcoholic Beverage Rule 7A-3.024, 7A-3.031 and 7A-4.0371 and are not in violation thereof.
Authorized Signature

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