INSTRUCTIONS FOR COMPLETING DBPR ABT- 6009 DIVISION OF ALCOHOLIC BEVERAGES & TOBACCO CHANGE OF BUSINESS NAME OR CHANGE OF MAILING ADDRESS APPLICATION 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. GENERAL INSTRUCTIONS Please complete all information. All questions are applicable and must be answered fully and truthfully. You must provide an original application. All signatures must be original. Contact Person All communications regarding your application will be sent to the applicant at the mailing address provided. If you would like us to communicate with someone other than the applicant, please provide the information for that person in the section labeled “License Information”. If you have appointed a person to act on your behalf and make changes to the application paperwork, please provide a copy of the Power of Attorney indicating such person is authorized to make changes on your behalf. If you have appointed an attorney to act on your behalf and make changes to the application paperwork, please provide a copy of the letter of representation. APPLICATION CHECKLIST U Select the appropriate transaction below and comply with the corresponding application requirements. TRANSACTION Change of Business Name (Fee Required) Change of Mailing Address (No Fee Required) APPLICATION REQUIREMENTS Pay $10 fee (make check payable to the Division of Alcoholic Beverages and Tobacco) Complete DBPR ABT-6009 Division of Alcoholic Beverages and Tobacco Change of Business Name or Change of Mailing Address Application Complete DBPR ABT-6009 Division of Alcoholic Beverages and Tobacco Change of Business Name or Change of Mailing Address Application or you may complete online at: https://www.myfloridalicense.com/ HTU Auth. 61A-1.023, FAC UTH 1 American LegalNet, Inc. www.FormsWorkFlow.com DBPR ABT-6009 – Division of Alcoholic Beverages and Tobacco Change of Business Name or Change of Mailing Address Application STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form ABT-6009 Revised 09/2010 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. 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- CHECK TRANSACTION REQUESTED Transaction Type: Business Name Change ($10 Fee Required) Mailing Address Change (No Fee Required) License/Permit Number SECTION 2 - CHANGE OF BUSINESS NAME Series/Type Full Name of Applicant (This is the name the license is currently issued in) Old Business Name (D/B/A) New Business Name (D/B/A) License/Permit Number SECTION 3 - CHANGE OF MAILING ADDRESS Series/Type Full Name of Applicant (This is the name the license is currently issued in) New Mailing Address City State Zip Code SECTION 4 - APPLICANT SIGNATURE APPLICANT SIGNATURE ________________________________________Date__________________ Contact Person Telephone Number E-Mail Address ABT District Office Received / Date Stamp Auth. 61A-1.023, FAC 1 American LegalNet, Inc. www.FormsWorkFlow.com