Form Dbpr Abt-6004 - Examination Application Of Officer/stockholder (Page 4 of 9) in pdf

Form Dbpr Abt-6004 - Examination Application Of Officer/stockholder Page 4

SECTION 4 – SALES TAX

TO BE COMPLETED BY THE DEPARTMENT OF REVENUE

Trade Name (D/B/A)

The named applicant for a license/permit has complied with the Florida Statutes concerning registration for

Sales and Use Tax.

1. This is to verify that the current owner as named in this application has filed all returns and that all

outstanding billings and returns appear to have been paid through the period ending

___________________ or the liability has been acknowledged and agreed to be paid by the

applicant. This verification does not constitute a certificate as contained in Section 212.10 (1), F.S.

(Not applicable if no transfer involved).

2. Furthermore, the named applicant for an Alcoholic Beverage License has complied with Florida

Statutes concerning registration for Sales and Use Tax, and has paid any applicable taxes due.

Signed____________________________________________________Date_____________________

Title______________________________________________________

Department of Revenue Stamp:

SECTION 5 – CONTRACTS OR AGREEMENTS

These questions must be answered about this business for every person or entity listed. Copies of

agreements must be submitted with this application.

Trade Name (D/B/A)

Yes

Is there a management contract, franchise agreement, or service agreement in

connection with this business?

Yes

Are there any agreements which require a payment of a percentage of gross or net

receipts from the business operation?

Yes

Have you or anyone listed on this application, accepted money, equipment or

anything of value in connection with this business from a manufacturer or

wholesaler of alcoholic beverages?

Form Dbpr Abt-6004 - Examination Application Of Officer/stockholder Page 4