INSTRUCTIONS FOR COMPLETING DBPR ABT – 6030 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO ADMINISTRATIVE ESCROW REQUEST Application begins on page 2 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. http://www.myflorida.com/dbpr/abt/district_offices/licensing.html GENERAL INSTRUCTIONS Please complete all information. Incomplete applications will be returned. All questions are applicable and must be answered fully and truthfully. You must provide an original and a copy of the application. All signatures must be original. APPLICATION CHECKLIST TRANSACTION Administrative Escrow Request APPLICATION REQUIREMENTS Complete DBPR ABT-6030 Division of Alcoholic Beverages and Tobacco Administrative Escrow Request form 1 American LegalNet, Inc. www.FormsWorkflow.com 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. http://www.myflorida.com/dbpr/abt/district_offices/licensing.html ADMINISTRATIVE ESCROW REQUEST Please be advised that doing business as and operating under License Number and Series 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 2 American LegalNet, Inc. www.FormsWorkflow.com