INSTRUCTIONS FOR COMPLETING DBPR ABT – 6038 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR TAX EXEMPT WINE 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, Customer Contact Center, at (850) 487-1395. Please send your completed application and required fee(s) to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0783 GENERAL INSTRUCTIONS Please complete all information. Incomplete applications will not be reviewed. All questions are applicable and must be answered fully and truthfully. This application is taken under oath. You must provide an original copy of the application and a copy of all supporting documentation. All signatures must be original. APPLICATION CHECKLIST TRANSACTION Tax Exempt Wine Permit APPLICATION REQUIREMENTS Complete DBPR ABT-6038 Division of Alcoholic Beverages and Tobacco Application for Tax Exempt Wine Permit 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6038 – Division of Alcoholic Beverages and Tobacco Application for Tax Exempt Wine 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, Customer Contact Center, at (850) 487-1395. Please send your completed application and required fee(s) to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0783 Religious Order Monastery Church Religious Body SECTION 1 – CHECK PERMIT CATEGORY Minister Pastor Priest Rabbi SECTION 2 – APPLICANT INFORMATION Full Name of Applicant Organization Name Mailing Address City State Contact Person Telephone Number Zip Code Fax Number 1. The religious purpose for this wine to be used: 2. Estimated amount of wine in total gallons to be purchased annually: 1 American LegalNet, Inc. www.FormsWorkflow.com SECTION 3 – APPLICANT SIGNATURE NOTARIZATION REQUIRED Organization Name STATE OF___________________ _________________________________________________ Applicant Signature COUNTY OF_________________ _________________________________________________ Type or Print Name and Title 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 Date___________________ Permit Number________________________________________________ The wines ordered under this permit are to be used for religious or sacramental purposes. This permit allows continued purchases from any duly licensed wholesaler or retailer and is in effect until revoked by the Division of Alcoholic Beverages and Tobacco. Approved By: ________________________________________________ 2 American LegalNet, Inc. www.FormsWorkflow.com