INSTRUCTIONS FOR COMPLETING DBPR ABT- 6003 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR ONE/TWO/THREE DAY PERMIT OR SPECIAL SALES LICENSE 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 at least seven (7) days prior to the first date of the event to insure the permit is issued by the event date. 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 This application is used for obtaining a one, two, or three day permit to sell alcoholic beverages for consumption on the reported premises only. A special sales license may also be obtained from this application for the sale of alcoholic beverages for a period of up to three days. This license does not permit the sale of alcoholic beverages for consumption on the premises and only allows package sales in sealed containers. GENERAL INSTRUCTIONS Submitting Your Application for a One, Two, Three Day Permit The Division of Alcoholic Beverages and Tobacco, Bureau of Licensing, accepts applications for one, two, and three day events. Please complete all information. All questions are applicable and must be answered fully and truthfully. You must provide an original application and supporting documentation that may be required by the local authorities. All signatures must be original. APPLICATION REQUIREMENTS Florida Law for One/Two/Three Day Permit Per Florida Statute 561.422, upon the filing of an application and payment of a fee of $25 per permit, the division may issue a permit authorizing a bona-fide non-profit civic organization to sell alcoholic beverages for consumption on premises only for a period not to exceed 3 days for a single event, subject to any state law or municipal or county ordinance regulating the time for selling such beverages. Any such civic organization may be issued only three such permits per calendar year except in those counties or municipalities with special acts governing the number of permits allowed. Notwithstanding other provisions of the beverage law, any civic organization licensed under this section may purchase alcoholic beverages from a distributor or vendor licensed under the beverage law. All sections of the application must be completed except the section titled Affidavit for Special Sales License. This section does not pertain to obtaining One/Two/Three Day permits. Please note that the Affidavit of Applicant must have an original signature of an officer of the Non-Profit Civic Organization; or in the case of a church, synagogue, school, or fraternity/sorority, the signature of an authorized representative of the church, synagogue, school, or fraternity/sorority, and must be notarized. Zoning Approval This section only applies to applications for a One, Two, Three Day Permit. The city or county zoning authority in which the event or special sale will be held executes zoning approval. Please check with your local authority for their requirements. Applications must be submitted within 180 days of receiving this approval. Sales Tax Certification to be completed by the Florida Department of Revenue. Please take this application form to the Department of Revenue for their approval. Applications must be submitted within 90 days of receiving this approval. Corporate Registration or Proof of Non-Profit Status Corporations are required to be registered with the Florida Secretary of State, Division of Corporations, as “non-profit” and the status of the corporation must be “active.” Organizations NOT incorporated must submit one of the following: a letter outlining the purpose and the goals of the event and who will benefit from the event’s profits; organization’s National, State, or Local charter; organization’s by-laws, 501(c)3 registration, or Minutes of Meeting. If you have not already registered, you will need to contact the Florida Auth: 61A-5.0013, FAC 1 American LegalNet, Inc. www.FormsWorkFlow.com Department of State at (850) 488-9000 for further information. Your application will be considered incomplete without this active registration or proof of non-profit status. Sketch of Premises When the event of the non profit organization is being held at a location that is licensed for the sale of alcoholic beverages, a sketch of the entire premises must be submitted. If the event does not include the entire premises, the sketch must identify the area of the licensed premises where the event is to be held and must be a separate room or enclosure. The attestation included with this application must have the original signature of the permanent license holder and must be submitted by the non-profit group along with the application. There are several important points you should be aware of: 1. The drinking age is 21. Please ensure that no one under 21 years of age is served an alcoholic beverage or allowed to consume alcoholic beverages. 2. The purpose of this permit is to provide your non-profit organization with a permit to sell alcoholic beverages to generate funds for your civic or charitable cause. 3. Your organization, as the permit holder, is the ONLY entity that may receive any of the profits from the sale of alcoholic beverages on this permit. You must have responsible members of your organization at the alcoholic beverage sales location at all times. Your event CANNOT involve the SHARING OF ANY PROFITS OR RECEIPTS, or a “DONATION” to your cause if you obtain a temporary permit. Participation in this practice subjects your organization to jeopardy and denial of future alcoholic beverage permits. 4. All records of alcoholic beverage purchases and sales must be retained for examination by the Division of Alcoholic Beverages and Tobacco. 5. No 1/2/3 Day Permit will be issued to any organization in connection with any type of gambling activity, i.e. Casino Night, Las Vegas Night, Monte Carlo Night, etc. 6. If your event is cancelled due to acts of nature, and you plan to reschedule, you need to notify the division within 14 days of the cancellation so that you will be eligible for reissuance of the permit at no fee to you. Florida Law for Special Sales License Florida Statute 561.20(12)(a), upon the filing of an application and payment of a fee of $25 per permit, the division may issue a license authorizing the sale of alcoholic beverages in sealed containers only, for a period not to exceed 3 days. This license is issued only for the purpose of authorizing a sale pursuant to: levy and execution; bankruptcy; insurance companies in possession of alcoholic beverages; license suspension or revocation; goods damaged by a common carrier; bona fide wine collector; or pursuant to part 5 of chapter 679. APPLICATION CHECKLIST TRANSACTION One/Two/Three Day Permit Special Sales License Auth: 61A-5.0013, FAC APPLICATION REQUIREMENTS Pay $25 fee (make check payable to the Division of Alcoholic Beverages and Tobacco) Complete DBPR ABT-6003 Division of Alcoholic Beverages and Tobacco Application for One/Two/Three Day Permits or Special Sales License Pay $25 fee (make check payable to the Division of Alcoholic Beverages and Tobacco) Complete DBPR ABT-6003 Division of Alcoholic Beverages and Tobacco Application for One/Two/Three Day Permits or Special Sales License 2 American LegalNet, Inc. www.FormsWorkFlow.com DBPR ABT-6003 – Division Of Alcoholic Beverages and Tobacco Application for One/Two/Three Day Permits or Special Sales License STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form ABT- 6003 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 or your local district office. Please submit your completed application to your local district office at least (7) days prior to the first date of the event to insure the permit is issued by the event date. This application may be submitted by mail, 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.state.fl.us/dbpr/abt/contact/index.shtml SECTION 1 -- CHECK TRANSACTION REQUESTED Transaction Type: One/Two/Three Day Permit Special Sales License SECTION 2 – LICENSE INFORMATION Full Name of Applicant Organization (This is the name the license/permit will be issued in) Department of State Document # FEIN Number Business Name (D/B/A)or Name of Event Location of Event (Street and Number) City County State FL Zip Code State Zip Code Mailing Address (Street or P.O. Box) City Contact Person Phone Number ext. Date(s) Permit Desired ABT District Office Received / Date Stamp Auth: 61A-5.0013, FAC 1 American LegalNet, Inc. www.FormsWorkFlow.com SECTION 3 – SALES TAX TO BE COMPLETED BY THE DEPARTMENT OF REVENUE Full Name of Applicant Organization The named applicant for a license/permit has complied with the Florida Statutes concerning registration for Sales and Use Tax and has agreed to pay any applicable taxes due. Signed____________________________________________________Date_____________________ Title______________________________________________________ Department of Revenue Stamp: SECTION 4 - ZONING TO BE COMPLETED BY THE ZONING AUTHORITY GOVERNING THE EVENT LOCATION Location of Event (Street and Number) City County The location complies with zoning requirements for the temporary sale of alcoholic beverages pursuant to this application for a One/Two/Three Day Permit. Signed____________________________________________________Date_____________________ Title______________________________________________________ Auth: 61A-5.0013, FAC 2 American LegalNet, Inc. www.FormsWorkFlow.com SECTION 5 – DESCRIPTION OF PREMISES TO BE LICENSED AB&T AUTHORIZED SIGNATURE REQUIRED Business Name (D/B/A) or Name of Event Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which are contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar locations and any other specific areas which are part of the premises sought to be licensed. A multi-story building where the entire building is to be licensed must show each floor plan. Auth: 61A-5.0013, FAC 3 American LegalNet, Inc. www.FormsWorkFlow.com SECTION 6 - AFFIDAVIT OF APPLICANT FOR NON-PROFIT CIVIC ORGANIZATION ALCOHOLIC BEVERAGE PERMIT NOTARIZATION REQUIRED Full Name of Applicant Organization "This is to certify that the applicant requesting the permit in the above and foregoing application is a nonprofit civic organization and that the permit, if used, will be used only by the organization making application, on the date(s) requested and at the location stated. This is to further certify that the applicant organization has not received more than three (3) permits within the calendar year and agree that the location may be inspected and searched during the time that the permit is issued and business is being conducted without a search warrant by authorized agents or employees of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for purposes of determining compliance with the alcoholic beverage laws. I, the undersigned individual, hereby swear or affirm that I am duly authorized to make the above and foregoing statements on behalf of the applicant organization. Furthermore, I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45, and 837.06, Florida Statutes, that the foregoing information is true to the best of my knowledge." STATE OF________________ COUNTY OF______________ _________________________________________________ APPLICANT SIGNATURE _________________________________________________ APPLICANT SIGNATURE The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of___________, 20__________, By _____________________________________who is ( ) personally known to me (print name(s) of person making statement) OR ( ) who produced ______________________________________________as identification. ________________________________________________ Commission Expires: ___________________ Notary Public Auth: 61A-5.0013, FAC 4 American LegalNet, Inc. www.FormsWorkFlow.com SECTION 7 - AFFIDAVIT OF APPLICANT FOR SPECIAL SALES LICENSE NOTARIZATION REQUIRED Full Name of Applicant Organization "I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that I am duly authorized to make the above and foregoing application for a special sales license which authorizes the sale of alcoholic beverages for period of up to three (3) days. I understand this license does not permit the sale of alcoholic beverages for consumption on the premises and only allows package sales in sealed containers and agree that the location may be inspected and searched during the hours that the special sale is being conducted without a search warrant by authorized agents or employees of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for purposes of determining compliance with the beverages laws. I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45, and 837.06, that the foregoing information is true to the best of my knowledge and that no other person or entity except as indicated herein has an interest in the special sales license and that all of the above listed persons or entities meet the qualifications necessary to hold this special sales license." STATE OF________________ COUNTY OF______________ _________________________________________________ APPLICANT SIGNATURE _________________________________________________ APPLICANT SIGNATURE The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of___________, 20__________, By _____________________________________who is ( ) personally known to me (print name(s) of person making statement) OR ( ) who produced ______________________________________________as identification. ________________________________________________ Commission Expires: ___________________ Notary Public Auth: 61A-5.0013, FAC 5 American LegalNet, Inc. www.FormsWorkFlow.com ATTESTATION This form is to be completed by the alcoholic beverage license holder ONLY when the event of the non profit organization is being held at a location that is licensed by the Division of Alcoholic Beverages & Tobacco for the sale of alcoholic beverages. Note: This attestation must have the original signature of the alcoholic beverage license holder (only persons on file with the division may sign) and must be submitted by the non-profit group along with the application for the One/Two/Three Day Permit. Licensee: Business Name (DBA): License #: Series of Permanent License: Type: Name of Non-Profit Group: Date(s) of Event I M PO RTANT A One/Two/Three Day permit is being requested for an event to be held on your licensed premises. During the event, no sales or service of alcoholic beverages may be made under your alcoholic beverage license in the area identified for use by the non-profit organization. Failure to comply will result in administrative charges being filed against your license. Signature of Licensee: __________________________________________________________________ Date: ______________________________ Auth: 61A-5.0013, FAC 6 American LegalNet, Inc. www.FormsWorkFlow.com