DBPR ABT-6032 – Division of Alcoholic Beverages and Tobacco Surety Bond Form STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form AB&T ABT-6032 Revised 09/2010 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 submit your completed form and required information to your local Auditing District Office at the address listed in the instru ction sheet. SECTION 1 – BOND INFORMATION Bond Amount Bond Number Please Check One: Alcoholic Beverages _______________ Manufacturer JDBW Distributor KLD Distributor Bonded Warehouse Cigarettes Tax-paid Distributor Stamping Distributor-Cash Stamping Distributor-Charge Distributing Agent Exporter Tobacco Products Distributor SECTION 2 – APPLICANT INFORMATION Name________________________________________________________________________________ (As it appears on application, license or permit) d.b.a. ______________________________________________ License Number ____________________ (Trade Name (D/B/A) (If Applicable) doing business in__________________________________ County, State of _______________________, As Principal, and _______________________________________________________________________ (Name of Licensed Surety Company) of _____________________________________________________________ (Street or P.O. Box) City ____________________________ State ___________________________ Zip Code______________ As Surety are bound to the State of Florida as of ________________________, Yr. ___________________ in the amount of $__________________ for which we bind ourselves, our heirs, personal representatives, successors and assigns, jointly and severally. The condition of this bond is that, if the Principal shall account for and pay over promptly to the Division of Alcoholic Beverages and Tobacco all money due or which shall become due the State of Florida for taxes due on the Principal's operations and shall otherwise comply with the provisions of the: Check one: Beverage Laws (Chapters 561-568, F.S.) Cigarette Laws (Chapter 210, F.S., Part I) Tobacco Product Laws (Chapter 210, F.S., Part II) of the State of Florida, then this obligation shall be void; otherwise, it shall remain in full force and effect. 1 American LegalNet, Inc. www.FormsWorkFlow.com IT IS MUTUALLY AGREED AND UNDERSTOOD BETWEEN ALL PARTIES HERETO, that if the Surety shall so elect, this bond may be cancelled and discontinued by giving sixty days notice in writing to the Division of Alcoholic Beverages and Tobacco, and this bond shall be deemed cancelled at the expiration of said sixty days, the said Surety remaining liable for all or any act or acts covered by this bond which may have been committed by the Principal up to the date of cancellation, under the terms, conditions, and provisions of this bond. Signed and Sealed on:____________________________ ___________________________________________ __________________________________________ (Name of Applicant) (Name of Surety Company) ___________________________________________ __________________________________________ (Signature of Principal/Applicant) (Signature and Office for Surety) AB&T USE ONLY AUDIT APPROVAL D.O. __________________ _____/____/_______ C.O. ________________ ____/____/_______ 2 American LegalNet, Inc. www.FormsWorkFlow.com