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Instructions For Completing Dbpr Abt - 6035 Form - Division Of Alcoholic Beverages And Tobacco Page 5

Section 8 – Health

This portion must be completed by the Division of Hotels & Restaurants or the local health authority for all

consumption on the premises (COP) license applications. This includes all applications for transfer,

change of location, and increase in series.

Section 9 – Contracts or Agreements

These are to be answered about this business for every person or entity listed. Copies of executed

agreements must be submitted with this application.

Section 10 – Corporate Felony Conviction

Answer yes only if the applicant is a corporation and the corporation has been convicted of a felony within

the last 15 years. If the answer is “yes”, list specific details.

Section 11 – Special License Requirements

If this application is for a quota or special license, the applicant must acknowledge the minimum

requirements to be met and maintained in order to qualify for these license types. These requirements

can be found on the web at

Please indicate the appropriate special license requirement and initial and date in the designated area, if

this applies to you.

Section 12 – Disclosure of Interested Parties

Question 1: List the names, titles and percentage of stock held for all officers, directors,

stockholders, limited partners and general partners, managing members, etc.

Question 2: List any persons not listed in Question 1 that are connected directly or indirectly with

the business. This would include guarantors, co-signors, and lenders.

Section 13 – Affidavit of Applicant(s)

The application must be signed by the applicant and notarized. If a sole proprietorship, the sole

proprietor must sign. If a general partnership, all partners must sign. If a corporation or other legal entity,

only the signature of one officer/member, etc. is required. All signatures must be original.

Section 14 – Affidavit of Transferor(s)

Transfer applications must be signed by the current license holder and notarized. The rules for who must

sign are the same as for Affidavit of Applicant(s). All signatures must be original.

Section 15 – Current Licensee Update Data Sheet

If anyone listed on this application currently holds a beverage license in the State of Florida, please

complete this section.

Section 16 – Department of Revenue Clearance

Department of Revenue clearance is required on applications for transfer applications wherein the

ownership of the license is being changed. This section of the application should be submitted directly to

the Department of Revenue. Do not return with this application.

Instructions For Completing Dbpr Abt - 6035 Form - Division Of Alcoholic Beverages And Tobacco Page 5