Form Dbpr Abt-6030 - Administrative Escrow Request printable pdf download

Form Dbpr Abt-6030 - Administrative Escrow Request

DBPR ABT-6030 – Division of Alcoholic Beverages and Tobacco Administrative Escrow Request

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 or your local district office. Please submit your

completed application to your local district office. This application may be submitted by mail, through

appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be

found on AB&T’s page of the DBPR web site at the link provided below.

ADMINISTRATIVE ESCROW REQUEST

Please be advised that

doing

business as

and

operating under License Number

does not have right of occupancy to the following

location:

(Address)

The above location has been leased to

doing business as

effective

We request that License Number

be removed from the above location and placed in

administrative escrow by the Division of Alcoholic Beverages and Tobacco so that our tenant can obtain a

new alcoholic beverage license and/or tobacco permit.

Signature of Landlord or Rental Agent

Company

Form Dbpr Abt-6030 - Administrative Escrow Request