INSTRUCTIONS FOR COMPLETING DBPR ABT– 6017 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION AND INSPECTION REPORT FOR OFF-PREMISES STORAGE PERMIT 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 The application and inspection report for off-premises storage of alcoholic beverages is filed with the Division of Alcoholic Beverages and Tobacco. 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 REQUIREMENTS Sketch of Premises Draw, in ink, a complete sketch of the premises which includes all walls, doors, counters, sales areas, storage areas, etc. No architectural drawings are accepted. APPLICATION CHECKLIST TRANSACTION Off-Premises Storage Permit APPLICATION REQUIREMENTS ‰ Complete DBPR ABT-6017 Division of Alcoholic Beverages and Tobacco Application and Inspection Report for Off-Premises Storage Permit ‰ Submit a complete sketch of Storage Premises with this application 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6017 – Division of Alcoholic Beverages and Tobacco Application and Inspection Report for Off-Premises Storage Permit 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 SECTION 1 - APPLICANT INFORMATION Trade Name (D/B/A) Full Name of Applicant Location Address City County Beverage License Number Series State Zip Code Type Location Address of Proposed Off-Premises Storage (must differ from licensed premises address) City County 2 State Zip Code American LegalNet, Inc. www.FormsWorkflow.com SECTION 2 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED Trade Name (D/B/A) “I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that the accompanying sketch or blue print is substantially a true and correct representation of the storage premises to be permitted and agree that the storage premises, if approved, may be inspected and searched during business hours or at any time the premises is occupied without a searched warrant by officers of the Division of Alcoholic Beverages and Tobacco, the sheriff, his deputies, and police officers. I further agree that in the event said premises are altered or any additions are made thereto, such alterations or added portions to the said premises may be inspected in the same manner and by the same officers as is agreed to in the case of the original premises that may be licensed. I further agree that the accompanying sketch will become and is a part of the application for a permit.” STATE OF___________________ _________________________________________________ APPLICANT SIGNATURE COUNTY OF_________________ The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this _______Day of________________ 20_____, By _____________________________ who is ( ) personally known to me OR ( ) who produced ____________________________ as identification. ____________________________________________ Commission Expires: Notary Public For Division Use Only SECTION 3 - REPORT OF INSPECTING OFFICER Date of Inspection The above premises have been inspected and it is recommended that the application be: ‰ Approved ‰ Disapproved Comments: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Inspector’s Signature _______________________________________________Date________________ 3 American LegalNet, Inc. www.FormsWorkflow.com SECTION 4 - SKETCH OF STORAGE PREMISES Trade Name (D/B/A) Sketch Verified By_______________________________________________ Date_________________ 4 American LegalNet, Inc. www.FormsWorkflow.com DISTRICT OFFICE ACTION Trade Name (D/B/A) ‰ Approved ‰ Disapproved Signature: _________________________________ 5 American LegalNet, Inc. www.FormsWorkflow.com