INSTRUCTIONS FOR COMPLETING DBPR ABT – 6019 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO NOTIFICATION FOR CHANGE IN WHOLESALE DISTRIBUTORS 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 Use this form to add or delete Florida wholesale distributors on currently registered brands/labels. GENERAL INSTRUCTIONS Please complete all information. Incomplete applications will be returned. All questions are applicable and must be answered fully and truthfully. APPLICATION INSTRUCTIONS 1. Enter the Registrant or Primary American Source of Supply name and Master Number in section 1 of this application. 2. For each brand/label to be changed, enter the brand number and name in section 2. 3. In section 3, enter the business name for identification purposes, then list the business name and city location of each Florida wholesale distributor you wish to add or delete. 4. Sign and date the application in section 4. 5. Submit the completed application to the DBPR address provided above. APPLICATION CHECKLIST TRANSACTION Change Florida Wholesale Distributor APPLICATION REQUIREMENTS ‰ Complete DBPR ABT-6019 Division of Alcoholic Beverages and Tobacco Notification for Change in Wholesale Distributors 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6019 – Division of Alcoholic Beverages and Tobacco Notification for Change in Wholesale Distributors 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, (850) 488-8284. Please send your completed application to: Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-1021 SECTION 2 – BUSINESS INFORMATION Registrant or PAS Master Number SECTION 3 – BRAND INFORMATION (Attach additional sheets as necessary) License # Brand Number Brand Name 2 American LegalNet, Inc. www.FormsWorkflow.com SECTION 3 – FLORIDA WHOLESALE DISTRIBUTORS (Attach additional sheets as necessary) Registrant/PAS Name Florida Distributors to be Added Business Name City Florida Distributors to be Deleted Business Name City SECTION 4 – APPLICANT SIGNATURE Signature____________________________________________________________ Date _____________ Title__________________________________________ 3 American LegalNet, Inc. www.FormsWorkflow.com