Dbpr Abt 6001 Form – Fill Out and Use This PDF

INSTRUCTIONS FOR COMPLETING

DBPR ABT– 6001

DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO

APPLICATION FOR NEW ALCOHOLIC BEVERAGE LICENSE

If you have any questions or need assistance in completing this application, please contact the Division of Alcoholic Beverages & Tobacco’s (AB&T) local district office. Please submit your completed application and required fee(s) 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 web site at the link provided below:

http://www.myfloridalicense.com/dbpr/abt/district_offices/licensing.html

GENERAL INSTRUCTIONS

Submitting Your Application

Applications for new alcoholic beverage licenses are filed with the Division of Alcoholic Beverages and Tobacco. Please complete all information. All questions must be answered fully and truthfully. You must provide an original application with original signatures. If you are required to submit any supporting documentation, such as the items listed below, a copy of the document is acceptable. Once submitted, your application cannot be returned to you. We will notify you in writing if your application has any errors or omissions and you will be given the opportunity to submit the corrected or required document.

Note: When applicable, you must submit a legible and executed copy of the following: Right of Occupancy, lease, or deed (must be in the name of the entity applying for the license), Franchise Agreement, Management Contract, Concession Agreement, and any agreement which requires a percentage payment from the business operation, Certified Copy of Death Certificate, Letters of Administration, Certificate of Title, Certified Copy of all Court Orders pertaining to the alcoholic beverage license.

If eligible, a temporary license may be purchased. Permanent and temporary license fees may be found at http://www.myfloridalicense.com/dbpr/abt/forms/documents/abtdistrictofficelist.pdf.

Contact Person

All communications regarding your application and invoices for payments of initial and renewal fees will be sent to the applicant/licensee at the mailing or email address provided. However, if you would like for us to communicate with someone other than the applicant regarding your application, please provide the name and contact information for that person in the “License Information” section. Your named contact person will be permitted to make changes to the application paperwork on your behalf (except Related Party Personal Information Sheet) and we will communicate directly with them regarding any application issues or deficiencies, and you will not be copied by the division with the correspondence. Once the application is approved, all invoices and any subsequent communications will be sent to the mailing address of the licensee.

APPLICATION REQUIREMENTS AND INSTRUCTIONS FOR COMPLETING THIS APPLICATION

License Types

Refer to the “Alcoholic Beverages and Tobacco” page on the Department of Business and Professional Regulation’s Internet site for the License Type data chart. This is provided to guide applicants in knowing how each license type is defined in order to clarify which license type suits their needs. http://www.myfloridalicense.com/dbpr/abt/documents/LicenseSeriesTypesABT2004_table.pdf

Zoning Approval

Zoning approval is executed by the city or county zoning authority in which the business to be licensed is located. Zoning approval is required on all new and change of location applications unless the applicant is a state college or university located on State owned property. Zoning approval may also be required

for certain change or increase in series applications. Zoning approval is not required on new applications for 1APS licenses unless required pursuant to a Special Act for the county in which you are applying. This information can be found at http://www.myfloridalicense.com/dbpr/abt/forms/documents/abtdistrictofficelist.pdf.

Auth. 61A-5.010 & 61A-5.056, FAC

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Department of Revenue Clearance

Department of Revenue clearance is required on applications for all new, transfer, change of location, and applications which change the licensee’s name. The address for the office serving your area of interest can be found at http://www.myfloridalicense.com/dbpr/abt/forms/documents/abtdistrictofficelist.pdf.

Health Approval

Health approval is required on all applications for consumption on the premises. Businesses that serve food or are located on premises licensed by the Division of Hotels and Restaurants, must obtain approval from that division. Businesses that do not serve food must contact the County Health Authority or the Department of Health. Food service establishments located in grocery and convenience stores, bakeries or delicatessens must contact the Department of Agriculture and Consumer Services. The address for the office serving your area of

interest can be found at http://www.myfloridalicense.com/dbpr/abt/forms/documents/abtdistrictofficelist.pdf.

Affidavit of Applicant

Read and sign in the presence of a notary. The affidavit must be signed by the individual applicant, each partner of a general partnership, a general partner of a general partnership of a limited partnership, a managing member, manager, or officer of a limited liability company, each partner of a limited liability partnership, or one of the officers of a corporate applicant.

Fingerprints

Note: If you are a current licensee with the Florida Division of Alcoholic Beverages & Tobacco you are not required to submit a new set of fingerprints with your application unless you have been arrested since your prior submission of fingerprints to the division. If you are not a current licensee but have been fingerprinted for this division in the past three (3) years, and you have not been arrested since that time, you are not required to submit new fingerprints unless the prior application was withdrawn or non-consummated. Applicants whose fingerprints are returned to the division as illegible will be required to submit a second set of fingerprints.

Fingerprints must be submitted by each sole proprietor; officers, directors, individual share holders owning more than ½ of 1 percent of stock in non-public corporations; general partners of general partnerships; general partners of a limited partnership; officers, managing members or managers of a limited liability company; partners of a limited liability partnership, and persons directly interested and receiving financial proceeds from the business.

Applicants must use a Livescan vendor that has been approved by the Florida Department of Law Enforcement to submit their fingerprints to the department. Costs associated with the fingerprint process will be collected by the vendor. Vendor options and contact information can be viewed at Livescan Device Vendors List (Livescan Device Vendors List). Please ensure that the Originating Agency Identification (ORI) number for the Division of Alcoholic Beverages and Tobacco is provided to the vendor when you submit your fingerprints. The ORI number is FL920150Z. If you do not provide the ORI number, or if you provide an incorrect ORI number to the vendor, the Department of Business and Professional Regulation will not receive your fingerprint results.

Out of State Alcoholic Beverage and Tobacco Applicants only:

Your fingerprint card can be obtained from the Department of Business and Professional Regulation by contacting the Division of Alcoholic Beverages and Tobacco at 850.488.8284, or one of the division’s district offices. A listing of the district offices on the web can be found at http://www.myfloridalicense.com/dbpr/abt/district_offices/licensing.html

Out of state applicants must be fingerprinted by a law enforcement agency on cards provided by the division (note: law enforcement agencies may charge for this service). The Division of Alcoholic Beverages and Tobacco has a unique ORI number that is required for processing the fingerprints back to the division, therefore, you must contact one of our offices to make a request for a card to be mailed to you.

Once your fingerprint card is received, you may then go to a local law enforcement office in your area to have your fingerprints rolled onto the card. Other information will be completed at the local law enforcement agency. For all programs, the completed card must be mailed to Pearson VUE at: FLDBPR, Florida Fingerprinting Program, Prints Inc. 119 East Park Avenue, Tallahassee, FL 32301 where the fingerprint card will be scanned. Prior to mailing your fingerprint card, you must complete the following steps in order to make advance payment of $54.50 (do not send any money to PrintsInk, please follow the procedure below):

OUT OF STATE LIVESCAN FINGERPRINTING REGISTRATION DIRECTIONS with Pearson VUE and or its subcontractor Morpho Trust (formerly known as L‐1)

1.Log onto the Pearson VUE website at https://pearson.ibtfingerprint.com/

Auth. 61A-5.010 & 61A-5.056, FAC

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2.Select Continue in English

3.Enter your legal first and last name.

4.Choose your agency from the drop down list

5.Select Pay For Ink Card Submission

6.Complete all of the required demographic information

7.Once you have entered your information select “Send” at the bottom of the page and you will be provided a verification page. You should verify that all the information you provided is correct and that you are being printed for the correct agency.

8.If everything is correct select “Go” at the top of the page and you have completed the entering of the required demographic information.

9.Choose your form of payment the option and then “Select”. At this time you will be able to enter either your

credit/debit card information, or e

‐CHECK INFORMATION.

10.Print the confirmation page. NOTE: you MUST include a copy of the confirmation page in the package with the fingerprint card sent to Prints Ink. Failure to provide the confirmation page may cause a delay in processing your fingerprint card.

PLEASE NOTE: Failure to follow these instructions and make payment will result in your fingerprint card being returned to you and delay the processing of your fingerprints, and therefore, your application. To check on the status of your card, please call 1-800-528-1358 and not PrintsInk.

Social Security Number

Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance, disclosure of social security numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598, and 559.79, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and are used for licensee identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), 104 Pub.L.193, Sec. 317. The State of Florida is authorized to collect the social security number of licensees pursuant to the Social Security Act, 42 U.S.C. 405(c)(2)(C)(I). This information is used to identify licensees for tax administration purposes, and the division will redact the information from any public records request.

Directly/Indirectly Interested Person

A direct interest is created by a person or entity having an interest with the applicant in the business sought to be licensed and, includes but is not limited to:

1.an interest which is created by virtue of the interested party deriving revenue from the sale of alcoholic beverages;

2.a person or entity having the right to receive revenue based on a contractual relationship related to the control of the sale of alcoholic beverages, the terms of which, are contrary to 561.17, Florida Statutes, or 61A-3.017, Florida Administrative Code;

3.a person or entity who has a right to a percentage payment from the proceeds of the business pursuant to a lease;

4.a guarantor on a lease or loan;

5.a co-signer on a lease or loan.

An indirect interest includes, but is not limited to, any person or entity that derives revenue from the license solely through a contractual relationship with the licensee, the substance of which is not related to the control of the sale of alcoholic beverages, or is specifically exempt by statute or rule.

Note: Direct and indirect interests must be disclosed in the “DISCLOSURE OF INTERESTED PARTIES” section of the application.

Registration of Legal Entity

All corporations, domestic or foreign; general partnerships; limited liability companies; limited liability partnerships; and limited partnerships are required to be registered with the Florida Department of State, Division of Corporations. If you have not already registered, you will need to contact the Department of State at (850)

488-9000 or www.sunbiz.org for further information. Your application will be considered incomplete without this active registration.

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Related Party Personal Information

This section of the application must be completed by each applicant or person(s) directly connected with the business, unless they are a current licensee. The signature of each person filling out this section of the application must be an original. This will include the sole proprietor, all partners, officers, directors, individual share holders owning more than ½ of 1 percent of stock in non-public corporations, all partners of each general partnership, all general partners of a limited partnership, all managing members or managers of a limited liability company, partners of a limited liability partnership, and persons directly interested and receiving financial proceeds from the business. It is important that each individual discloses any arrests they have had within the past 15 years, even if they were charged, but not formally arrested, and regardless of the disposition.

Copy of Arrest Disposition

If the applicant answers “yes” to any of the criminal background questions asked in this application, provide a copy of the Arrest Disposition to ensure the applicant is qualified, pursuant to Statute and Rule.

Applicable Statutes and Rule: 561.15 & 561.17, Florida Statutes; and 61A-1.017, Florida Administrative Code.

Moral Character

The applicant is required to meet the moral character standards to have an interest in an alcoholic beverage license. Any person failing to meet those standards shall be required to submit mitigation under the moral character rule in order for the division to determine if the person is qualified. A copy of the rule and requirements can be found at https://www.flrules.org/gateway/RuleNo.asp?title=DEFINITIONS&ID=61A-1.017.

Federal Employer's Identification Number (FEIN)

All licensees who pay wages to one or more employees must have a Federal Employer's Identification Number. Contact the Internal Revenue Service (IRS) at 1-800-829-3676 and request Form #SS4.

Surety Bond

Surety bonds are required on all new applications for manufacturers, wholesale distributors of alcoholic beverages, wholesale distributors of cigarettes, and other tobacco products. A surety bond or a rider to the original bond must be submitted on any change of business name, change of location or change of ownership name application by the aforementioned. You may wish to have an auditor review your surety bond prior to submitting this application. Contact the division's Auditing Office serving your area of interest for further information. A list of the Auditing offices can be found at: http://www.myfloridalicense.com/dbpr/abt/district_offices/auditing.html.

Sketch of Premises

A complete sketch of the premises, drawn in ink or computer generated (letter size) which includes all permanent walls, doors, windows, counters, labeling each room and area. Include any outside areas where alcoholic beverages will be sold, consumed, or served. Due to the difficulty of scanning, no blueprints are accepted.

APPLICATION CHECKLIST

	TRANSACTION			APPLICATION REQUIREMENTS
				 Complete DBPR ABT-6001 Division of Alcoholic Beverages and
				Tobacco Application for New Alcoholic Beverage License
				 Pay $100 or ¼ of the annual license fee, whichever is greater, if
				requesting a temporary license (make check payable to the Division
				of Alcoholic Beverages and Tobacco)
	New License			 Submit Fingerprint receipt, if applicable
				 Submit a copy of Arrest Disposition, if applicable
				 Submit Mitigation for Moral Character, if applicable
				 Manufacturers and wholesale distributors of alcoholic beverages
				must complete and submit the DBPR ABT-6032 Surety Bond form
				 Submit Right of Occupancy
	Application may also include			 New Retail Tobacco Products Dealer Permit

Auth. 61A-5.010 & 61A-5.056, FAC

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DBPR ABT-6001 – Division of Alcoholic Beverages and Tobacco

Application for New Alcoholic Beverage License

STATE OF FLORIDA	DBPR Form
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION	ABT-6001
	Revised 08/2013

If you have any questions or need assistance in completing this application, please contact the Division of Alcoholic Beverages & Tobacco’s (AB&T) local district office. Please submit your completed application and required fee(s) 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 web site at the link provided below:

http://www.myflorida.com/dbpr/abt/district_offices/licensing.html

SECTION 1 - CHECK LICENSE CATEGORY

License Series Requested		Type/Class Requested			Do you wish to purchase a Temporary License?
					Yes	No
Child License Requested		Number of Child Licenses Requested
Retail Alcoholic Beverages			Alcoholic Beverage Manufacturer
			Passenger Waiting Lounge
Beer/Wine/Liquor Wholesaler
Retail Tobacco Products Dealer Permit (must check one or more of the below)
Pipes	Over the Counter		Vending Machine

SECTION 2 – LICENSE INFORMATION

If the applicant is a corporation or other legal entity, enter the name and the document number as registered with the Florida Department of State Division of Corporations on the line below.

Business Name (D/B/A)

Location Address (Street and Number)

City	County	State	Zip Code
		FL
Mailing Address (Street or P.O. Box)

Contact Person - This section is optional, see application instructions for details

Contact Person

Telephone Number

ext.

E-Mail Address (Optional)

Mailing Address (Street or P.O. Box)

ABT District Office Received Date Stamp

Auth. 61A-5.010 & 61A-5.056, FAC

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