Dbpr Form Ab&t 4000a-125-1 - Beverages Shipped To / Within Florida
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1DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-125-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE, FL 32399-1022
BEVERAGES SHIPPED TO / WITHIN FLORIDA
MALT BEVERAGES shipped to / within Florida during the month of
Yr
Name
Address
City
State
Zip
Telephone No. (
)
Contact Person
List each shipment and file on or before the 10th of each month to the address above, ATTN: Bureau of Auditing
16 OZ or
> 16 OZ to
CONSIGNEE'S CITY
INVOICE
BULK
NAME OF CONSIGNEE
LESS
32 OZ
GALLONS
LOCATION
DATE
NUMBER
CONTAINER
CONTAINER
Subtotals this page
GRAND TOTALS FOR MONTH
Individual containers of 32 ounces or less shall have imprinted thereon in clearly legible fashion, by any permanent method, the word "Florida" or "FL", and no other
name or abbreviation of any state name, in not less than 8-point type. For exemption approval, contact DAB&T, Bureau of Licensing, Brand Registration Section.
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