Dbpr Form Ab&t 4000a-400 - Smoking Designation Procedures Report
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1DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-400
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
SMOKING DESIGNATION PROCEDURES REPORT
Every third year after the initial designation, on or before the licensee's annual license renewal, the licensed vendor must additionally provide
to the division an agreed upon procedures report in a format established by rule of the department from a Florida certified public accountant
that attests to the licensee's compliance with the percentage requirement of s. 386.203(11) for the preceding 36-month period. Such report
shall be admissible in any proceeding pursuant to s. 120.57. This subsection does not apply to a stand-alone bar if the only food provided by
the business, or in any other way present or brought onto the premises for consumption by patrons, is limited to nonperishable snack food
items commercially prepackaged off the premises of the stand-alone bar and served without additions or preparation; except that a stand-
alone bar may pop popcorn for consumption on its premises, provided that the equipment used to pop the popcorn is not used to prepare any
other food for patrons.
License Name
License No.
Phone No. (
)
License Location
City
FL
Zip
Owner's Name
Period of Report
CPA Name
CPA License No.
Expiration
CPA Company Name
YEAR
GROSS SALES TOTALS
PERCENTAGE OF FOOD
SALES REVENUE
FOOD REVENUE
REVENUE
TOTALS FOR
PERIOD
Instructions:
1.
YEAR: List each year included in the 3 year report.
2.
SALES REVENUE: List total gross revenue from all sales for each year.
3.
FOOD REVENUE: List total gross revenue from food sales for each year.
4.
PERCENTAGE OF FOOD REVENUE: Divide the total gross revenue from all sales into the total gross
revenue from the sale of food consumed on the licensed premises. (Total food revenue / total sales
revenue = percentage of total revenue).
This report is true and correct to the best of my
knowledge and belief and is submitted under penalty
of perjury.
Accountant's Signature
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