INSTRUCTIONS FOR COMPLETING DBPR ABT – 6022 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR MORTGAGEE’S INTEREST IN SPIRITOUS ALCOHOLIC BEVERAGE LICENSE If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, at (850) 488-8284. Please send your completed application and required fee(s) to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-1021 GENERAL INSTRUCTIONS You must provide an original of the application and executed copies of all supporting documentation. All signatures must be original. Please complete all information. All Questions are applicable and must be answered fully and truthfully. Indicate “N/A” (not applicable) for questions that do not apply. APPLICATION REQUIREMENTS Pursuant to Section 561.65, Florida Statutes, a lien may only be recorded against a spirituous (liquor) license. The lien must be submitted to the Division of Alcoholic Beverages and Tobacco within 90 days of the creation of the lien or security interest. When a lien is accepted or rejected, written notification will be sent advising you accordingly. The processing time for lien recordings varies by each application. Lien Recordings 1. Enclose a filing fee of $10 per lien, per license. Please make checks payable to the Division of Alcoholic Beverages & Tobacco. 2. Complete all sections. Section 6 must be signed by the person pledging the license as collateral (debtor) and the secured party. 3. A copy of the dated and executed security agreement (which specifically pledges the alcoholic beverage license by number) and a promissory note outlining the terms of agreement must be attached to this form when submitted. Failure to do so will result in a delay in recording your lien since the lien cannot be recorded without these documents. Lien Assignments/Assumptions 1. Enclose a filing fee of $10 per lien, per license. Please make checks payable to the Division of Alcoholic Beverages & Tobacco. 2. Complete all sections. 3. Submit a copy of the Assignment Agreement signed by the original secured party. The Agreement should include the filing date of the lien being assigned, the alcoholic beverage license number, and the name and address of the new secured party, or submit a copy of the Assumption Agreement signed by the new debtor. The Agreement should include the filing date of the lien being assumed, the alcoholic beverage license number, and the name and address of the new debtor. Auth. 61A-5.0012, FAC 1 American LegalNet, Inc. www.FormsWorkFlow.com Lien Renewals or Extensions 1. Enclose a filing fee of $10 per lien, per license. Please make checks payable to the Division of Alcoholic Beverages & Tobacco. 2. Complete all sections. Section 6 must be signed by the secured party. 3. Submit a copy of the original agreement and promissory note or an executed Renewal or Extension Agreement. Lien Modification or Amendment 1. Complete all sections. Section 6 must be signed by the person pledging the license as collateral (debtor) and the secured party. 2. Submit a copy of the Modified/Amended Agreement signed by both parties. The Agreement should include the date of the modification/amendment, the alcoholic beverage license number, and the name and address of the secured party and the debtor. Lien Satisfactions The satisfaction of a lien does not require the completion of this or any other form. A $10 fee is required. The satisfaction may be accomplished in letter form over the signature of the secured party. The letter should be specific enough to identify the license and the lien which is being satisfied. Lien satisfactions must be sent to the Division of Alcoholic Beverages and Tobacco. Include “ATTN: Lien Recording Section” on your mailing envelope. APPLICATION CHECKLIST Select the appropriate transaction below and comply with the corresponding application requirements. TRANSACTION Lien Recordings (New Lien) Lien Assignment/Assumption Lien Renewal/Extension Lien Modification/Amendment Auth. 61A-5.0012, FAC APPLICATION REQUIREMENTS Pay $10 fee (make check payable to the Division of Alcoholic Beverages and Tobacco Complete all sections of DBPR ABT-6022 Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in Spirituous Alcoholic Beverage License form Submit a copy of the dated and executed security agreement Submit a copy of the promissory note outlining the terms of agreement Pay $10 fee (make check payable to the Division of Alcoholic Beverages and Tobacco) Complete all sections of DBPR ABT-6022 Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in Spirituous Alcoholic Beverage License form Submit a copy of the Assignment Agreement signed by the new secured party, if applicable Submit a copy of the Assumption Agreement signed by the new debtor, if applicable Pay $10 fee, per lien, per license (make checks payable to the Division of Alcoholic Beverages and Tobacco) Complete all sections of DBPR ABT-6022 Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in Spirituous Alcoholic Beverage License form Submit a copy of the original agreement and promissory note, or an executed Renewal or Extension Agreement Complete all sections of DBPR ABT-6022 Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in Spirituous Alcoholic Beverage License form Submit a copy of the Modified/Amended Agreement 2 American LegalNet, Inc. www.FormsWorkFlow.com DBPR ABT-6022 – Division of Alcoholic Beverages and Tobacco Application for Mortgagee’s Interest in Spirituous Alcoholic Beverage License STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form ABT-6022 Revised 09/2010 NOTE – This form must be submitted as part of an application packet If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, at (850) 488-8284. Please send your completed application and required fee(s) to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-1021 SECTION 1 - CHECK TRANSACTION REQUESTED Transaction Type: Lien Recordings (New Lien) Lien Assignment/Assumption Lien Renewal/Extension Lien Modification/Amendment SECTION 2 – DEBTOR(S) INFORMATION Full Name of Debtor Mailing Address City State Zip Code City State Zip Code City State Zip Code Full Name of Debtor (if more than one) Mailing Address SECTION 3 – SECURED PARTY(S) INFORMATION Full Name of Secured Party Mailing Address Full Name of Secured Party (if more than one) Mailing Address SECTION 4 – EFFECTIVE DATE OF SECURITY INTEREST (Month/Day/Year) SECTION 5 – ALCOHOLIC BEVERAGE LICENSE NUMBER This section is for reference purposes only. Alcoholic Beverage License must be specifically pledged, by number, as collateral in the Security Agreement. License Number Auth. 61A-5.0012, FAC 1 American LegalNet, Inc. www.FormsWorkFlow.com SECTION 6 – SIGNATURE OF DEBTOR AND SECURED PARTY REQUIRED NOTARIZATION REQUIRED ________________________________________ Signature of Debtor __________________________________________ Signature of Debtor ________________________________________ Print Name of Person signing as Debtor __________________________________________ Print Name of Person signing as Debtor STATE OF________________ COUNTY OF______________ The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of_______________, 20_____, By _______________________________________who is ( ) personally (print name(s) of person(s) making statement) known to me OR ( ) who produced ___________________________________________as identification. ________________________________________________ Commission Expires: ___________________ Notary Public ________________________________________ Signature(s) of Secured Party ________________________________________ Signature(s) of Secured Party ________________________________________ Print Name of Person(s) signing as Secured Party ________________________________________ Print Name of Person(s) signing as Secured Party STATE OF________________ COUNTY OF______________ The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of_______________, 20_____, By _______________________________________who is ( ) personally (print name(s) of person(s) making statement) known to me OR ( ) who produced ___________________________________________as identification. ________________________________________________ Commission Expires: ___________________ Notary Public Rejected Reason: FOR DIVISION USE ONLY – DO NOT WRITE BELOW THIS LINE Date Stamp Accepted Date_______ Initials_______________ Auth. 61A-5.0012, FAC 2 American LegalNet, Inc. www.FormsWorkFlow.com