Form Dbpr Abt-6001 - Examination Application For Alcoholic Beverage License And Tobacco Permit Page 9

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SECTION 10 – CORPORATE FELONY CONVICTION
Trade Name (D/B/A)
Has the applicant corporation been convicted of a felony in this state, any other state, or by the United
States in the last 15 years?
Yes
No
If the answer is “Yes,” please list all details including the date of conviction, the crime for which the
corporation was convicted, and the city, county, state and court where the conviction took place.
(Attach additional sheets if necessary)
SECTION 11 – SPECIAL LICENSE REQUIREMENTS
(DOES NOT APPLY TO BEER AND WINE LICENSES)
Please check the appropriate “Special Alcoholic Beverage License” box of the license for which you are
applying. Fill in the corresponding requirements for each Special License type.
Quota Alcoholic Beverage License
Special Alcoholic Beverage License
Club Alcoholic Beverage License
This license is issued pursuant to __________, Florida Statutes or Special Act, and as such we acknowledge
the following requirements must be met and maintained:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Please initial and date:
Applicant’s Initials___________________________ Date______________
9

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