INSTRUCTIONS FOR COMPLETING DBPR ABT - 6007 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO REQUEST FOR CANCELLATION OF PERMANENT LICENSE 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.state.fl.us/dbpr/abt/contact/index.shtml GENERAL INSTRUCTIONS Please complete all information. Incomplete applications will not be accepted. 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 Cancellation of Permanent License APPLICATION REQUIREMENTS Complete DBPR ABT-6007 Division of Alcoholic Beverages and Tobacco Request for Cancellation of Permanent License form 1 American LegalNet, Inc. www.FormsWorkflow.com DBPR ABT-6007 – Division of Alcoholic Beverages and Tobacco Request for Cancellation of Permanent License 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 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.state.fl.us/dbpr/abt/contact/index.shtml . SECTION 1 - APPLICATION INFORMATION Please cancel the following alcoholic beverage license: License Series/Class Issued To: License/Permit Number Business Name Licensee ID Number I do do not wish to cancel retail tobacco permit number: Is the permanent license accompanying this form? Yes No SECTION 2 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that I am duly authorized to make the above request. 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 correct. STATE OF___________________ _________________________________________________ APPLICANT SIGNATURE COUNTY OF_________________ The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged District Office Date Stamp Before me this _______Day of_____________, 20_____, By:_________________________________ who is ( ) personally known to me OR ( ) who produced ____________________________ as identification. __________________________________________ Notary Public 2 American LegalNet, Inc. www.FormsWorkflow.com