DBPR Form TS 6000-12 Revised: September 2001 FILING STATEMENT FOR ADVERTISING MATERIAL ALL ADVERTISING MATERIAL RELATING TO A TIMESHARE PLAN MUST BE FILED WITH THE DIVISION AND COMPLY WITH SECTIONS 721.05, 721.11 AND 721.111, FLORIDA STATUTES, AND CHAPTER 61B-37, FLORIDA ADMINISTRATIVE CODE, AS APPLICABLE. PRIZE AND GIFT PROMOTIONS REQUIRE A $100.00 FILING FEE. THIS FORM SHOULD BE FULLY COMPLETED AND ACCOMPANY ALL ADVERTISING SUBMISSIONS: NEW ADVERTISING PROMOTIONS AND AMENDMENTS TO EXISTING PROMOTIONS. I. Project Number: PR__________ II. Timeshare Plan Name and Address: ______________________________________ ______________________________________ ______________________________________ III. Developer Name and Address: ______________________________________ ______________________________________ ______________________________________ IV. Review Requested? : Yes [ _ ] No [ _ ] [See Sec. 721.11 (1), F.S.] V. Is this filing new [ _ ] or an amendment to an approved filing [ _ ]? If an amendment, provide the Reference Number from the original filing. _____________ VI. Is the prize or gift a lodging or vacation certificate, as defined by Rule 61B-37.001, Florida Administrative Code? Yes [ _ ] No [ _ ] VII. Is this timeshare plan complete [ _ ] or under construction [ _ ]? A. VIII. If under construction, provide the proposed completion date. ______________________ In accordance with Section 721.111 (5)(a)-(g), F.S., the following information must be provided to the Division: A. Section 721.111 (5)(a), F.S. Copies of all advertising material. B. Section 721.111 (5)(b), F.S. Supplier or manufacturer’s name, address and phone number: _____________________________________________________ _____________________________________________________ _____________________________________________________ C. Section 721.111 (5)(c), F.S. Manufacturer’s model number or other description of such item, as applicable: _______________________________________________________ D. Section 721.111 (5)(d), F.S. Information on which the developer relies in determining the verifiable retail value. Attach copies of this information. E. Section 721.111 (5)(e), F.S. Name, address and phone number (including area code) of the promotional entity responsible for overseeing and operating the prize and gift promotional offer. ____________________________________________________ ____________________________________________________ ____________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com DBPR Form TS 6000-12 Revised: September 2001 Phone No.____________________________________________ F. G. IX. Section 721.111 (5)(f), F.S. Name and address of the registered agent in this state of the promotional entity for service of process purposes. ____________________________________________________ ____________________________________________________ ____________________________________________________ Section 721.111 (5)(g), F.S. Full disclosure of ALL pertinent information concerning the use of the lodging and vacation certificates, including the terms and conditions of the campaign. Description of the proposed advertising program and how it works (Attach an additional sheet if necessary). _____________________________________________________________________________ _____________________________________________________________________________ ________________________________________________________ In accordance with Section 721.111(6)(a)-(e), Florida Statutes, all advertising must contain, but is not limited to the following: • • • • • A complete description of all items All rules, terms, requirements and pre-conditions The expiration date of the offer The method by which items are to be awarded The number of items to be awarded, if limited ADDITIONAL INFORMATION MAY BE REQUIRED BY STATUTE OR RULE. PLEASE REVIEW SECTIONS 721.05, 721.11 AND 721.111, FLORIDA STATUTES AND RULE 61B-37, FLORIDA ADMINISTRATIVE CODE, PRIOR TO SUBMITTING ADVERTISING MATERIAL. Submitted by ________________________________________ Title _________________________________________ Date _____________________ Phone No. ( ) __________________ American LegalNet, Inc. www.FormsWorkFlow.com