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DR-1S

R. 01/17

Business Partner Number: ______________________

Page 2

Location Information

___ ___- ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ - ___

Provide your Sales Tax Certificate Number for this location:

This application* is for:

Secondhand Dealer

Mail-in Secondhand Precious Metals Dealer

Automated Kiosk Secondhand Dealer

Secondary Metals Recycler

Location Business Name __________________________________________________________________________________________________

Physical street address (Do not use PO Box) ________________________________________________________________________________

City__________________________________________County_________________________State ________________ZIP___________________

For this location enter the total number of licenses applied for: __________

*Include a $6 fee for each location and each license type.

Location Information

___ ___- ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ - ___

Provide your Sales Tax Certificate Number for this location:

This application* is for:

Secondhand Dealer

Mail-in Secondhand Precious Metals Dealer

Automated Kiosk Secondhand Dealer

Secondary Metals Recycler

Location Business Name __________________________________________________________________________________________________

Physical street address (Do not use PO Box) ________________________________________________________________________________

City__________________________________________County_________________________State ________________ZIP___________________

For this location enter the total number of licenses applied for: __________

*Include a $6 fee for each location and each license type.

Total number of locations and

license types included in this

X $6.00 =

Application Fee Amount Enclosed:

application:

Under the penalties of perjury, I declare that I have read this application and that the facts stated in it are true.

______________________________________________________________

_________________________________________

_______________

Signature of Applicant

Title

Date

This application must be signed by an owner, officer, member, partner, director, or stockholder with a controlling interest in the business entity.

You will NOT be issued a Certificate of Registration if:

1. You are not registered to file and pay Florida sales and use tax.

2. You are younger than 18 years old.

3. You are applying for a secondhand dealer license and within the preceding 10 years, any business owner, officer, member,

director, partner, or stockholder with a controlling interest in the company was convicted of, or entered a plea of guilty or nolo

contendere to, or had adjudication withheld for, a crime against the laws of Florida or any other state in the United States relating

to registration as a secondhand dealer or involving theft, larceny, dealing in stolen property, receiving stolen property, burglary,

embezzlement, obtaining property by false pretenses, possession of altered property, any felony drug offense, any violation of

s. 812.015, F.S., or any fraudulent dealing.

4. You are applying for a secondhand dealer license and any business owner, officer, member, director, partner, or stockholder

with a controlling interest in the company ever had a final judgment entered against them in civil action upon grounds of fraud,

embezzlement, misrepresentation, or deceit.

5. You are applying for a secondary metals recycler license and:

(A) Within the preceding 24 months, any business owner, officer, member, director, partner, or stockholder with a controlling

interest in the company was convicted of, or entered a plea of guilty or nolo contendere to, a felony committed against the laws of

Florida or any other state in the United States involving theft, larceny, dealing in stolen property, receiving stolen property, burglary,

embezzlement, obtaining property by false pretenses, possession of altered property, any felony drug offense, or of knowingly or

intentionally violating the laws of Florida relating to registration as a secondary metals recycler, or

(B) You are registering a business location that does not meet the definition of a “fixed location.” Section 538.18, F.S., defines

“fixed location” to mean any site occupied by a secondary metals recycler as owner of the site or as lessee of the site under a

lease or other rental agreement providing for occupation of the site by the secondary metals recycler for a total duration of not less

than 364 days.

Form Dr-1sn - Registration Application For Secondhand Dealers And Secondary Metals Recyclers Page 4

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