Dbpr Form Ab&t 4000a-300-4 - Certificate Of Tobacco Products Destroyed - Department Of Business And Professional Regulation - Florida

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-300-4
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
CERTIFICATE OF TOBACCO PRODUCTS DESTROYED
Permit Name
Permit No.
Date
Address
Phone Number
(
)
City
State
Zip
Name of Supplier
Wholesale
(Attach a detailed listing of products for each supplier)
Sales Price
Total
(Forward the total to page 1, line 5)
We certify the Tobacco Products listed above as destrpyed is true and correct to the best of our knowledge and belief.
Licensee
Division of Alcoholic Beverages and Tobacco

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