INSTRUCTIONS FOR COMPLETING DBPR ABT – 6016 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR VEHICLE 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 This permit application is filed with the Division of Alcoholic Beverages and Tobacco. Please complete all information. 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 CHECKLIST TRANSACTION Vehicle Permit APPLICATION REQUIREMENTS Pay $5 fee (make check payable to the Department of Business and Professional Regulation) Complete DBPR ABT-6016 Division of Alcoholic Beverages and Tobacco Application for Vehicle Permit Submit Vehicle Registration 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6016 – Division of Alcoholic Beverages and Tobacco Application for Vehicle 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 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 Business Name Licensee Name Location Address City Make of Vehicle County State Zip Code SECTION 2 - VEHICLE INFORMATION Model Year Vehicle Identification Number Vehicle Tag Number SECTION 3 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that the referenced vehicle is owned or leased by the above entity and will be used to make deliveries of sales actually made at my licensed premises, or to transport alcoholic beverage purchases from a distributor’s licensed place of business to my licensed premises or authorized off-premises storage facility. Further, I understand that this permit is valid and will not expire unless the vehicle is disposed of, or my alcoholic beverage license is transferred, cancelled, not renewed, or revoked by the Division. I further agree that such vehicle is subject to be inspected and searched without a search warrant during business hours or other times the vehicle is being used to transport or deliver alcoholic beverages by officers of the Division of Alcoholic Beverages and Tobacco, the sheriff, his deputies, and police officers for the purpose of ascertaining compliance with the beverage laws. 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 2 American LegalNet, Inc. www.FormsWorkflow.com