INSTRUCTIONS FOR COMPLETING DBPR ABT – 6012 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR PASSENGER VESSEL 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 at (850) 488-8284. Please send your completed application to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-1021 . GENERAL INSTRUCTIONS Please complete all information. All questions are applicable and must be answered fully and truthfully. This application is taken under oath. Persons filing false applications or information may be prosecuted and the application denied. You must provide an original and a copy of the application and duplicate copies of all supporting documentation. All signatures must be original. APPLICATION REQUIREMENTS The application must be accompanied by a check in the amount of the license requested below. Make checks payable to the Department of Business and Professional Regulation. Corporate and Limited Partnership Registration All corporations, domestic or foreign, general partnerships, limited liability corporations, and limited partnerships are required to be registered with the Florida Secretary of State, Division of Corporations. If you have not already registered, you will need to contact the Department of State at (850) 488-9000 for further information. Your application cannot be accepted by this division without this registration. Series PVP (Passenger Vessel Permit): This permit type applies to a passenger vessel which has a cabin-berth capacity for at least 75 passengers, and which is engaged exclusively in foreign commerce, and allows the permittee to sell alcoholic beverages for consumption on board the vessel only: (a) During a period not in excess of 24 hours prior to departure while the vessel is moored at a dock or wharf in a port of this state; or (b) At any time while the vessel is located in Florida territorial waters and in transit to or from international waters. APPLICATION CHECKLIST TRANSACTION Passenger Vessel Permit (PVP) APPLICATION REQUIREMENTS Pay $1,100 Master License fee (make check payable to the Department of Business and Professional Regulation) Pay $550 Master License fee (if application is submitted after April 1, make check payable to the Department of Business and Professional Regulation) Complete DBPR ABT-6012 Division of Alcoholic Beverages and Tobacco Application for Passenger Vessel Permit Submit Secretary of State Certificate of Status, if applicable 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6012 – Division of Alcoholic Beverages and Tobacco Application for Passenger Vessel Permit STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 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 to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-1021 SECTION 1 - APPLICATION INFORMATION Full Name of Applicant Mailing Address City State Zip Code Contact Person Department Phone Number Is this applicant a corporation or other legal entity? Yes No If yes, the corporation or entity must be registered with the Florida Division of Corporations to conduct business in Florida. Corporate Document Number: SECTION 2 - PASSENGER VESSEL INFORMATION Name of Vessel Name of Florida Port City County As operator or concessionaire, we certify this passenger vessel cabin-berth capacity is for at least [___________] passengers and that it is engaged exclusively in foreign commerce. 2 American LegalNet, Inc. www.FormsWorkflow.com SECTION 3 - CORPORATE FELONY CONVICTION Trade Name (D/B/A) Has the applicant corporation been convicted of a felony in this state, any other state, or by the United States in the last 15 years? Yes No If the answer is “Yes,” please list all details including the date of conviction, the crime for which the corporation was convicted, and the city, county, state and court where the conviction took place. SECTION 4 - DISCLOSURE OF INTERESTED PARTIES Note: Failure to disclose an interest, direct or indirect, could result in denial, suspension and/or revocation of your license. List below the names of all persons connected, directly or indirectly, in the business for which the license is sought. Attach extra sheets if necessary. Trade Name (D/B/A) NAME OFFICE (if corporation) 3 American LegalNet, Inc. www.FormsWorkflow.com SECTION 5 - 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 agree that by acceptance of a permit, the place of business may be inspected and searched during business hours or at any time business is being conducted on the vessel without a search warrant by officers of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his deputies and police officers for purposes of determining compliance with the beverage law. I, or we, understand that any permit issued under this application authorizes the sale of alcoholic beverages for consumption on board the vessel only, during a period not in excess of 24 hours prior to departure while the vessel is moored at docks or wharfs in ports of this state; or at any time while the vessel is located in the Florida territorial waters and is in transit to or from international waters. I swear under oath or affirmation under penalty of perjury as provided in Sections 559.791, 562.45 and 837.06, Florida Statutes, that the foregoing information is true and that no other person(s), firm, or corporation, except as indicated herein, has an interest in the alcoholic beverage permit for which these statements are made.” STATE OF___________________ _________________________________________________ APPLICANT SIGNATURE COUNTY OF_________________ _________________________________________________ APPLICANT SIGNATURE 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 4 American LegalNet, Inc. www.FormsWorkflow.com