Dbpr Abt 6001 Form – Fill Out and Use This PDF

Under SECTION 1 - CHECK LICENSE CATEGORY, enter the License Series Requested and the Type/Class Requested. Do you wish to purchase a Temporary License? Yes No.

Child License Requested: Yes No. Enter the Number of Child Licenses Requested.

Check Alcoholic Beverage Manufacturer, Passenger Waiting Lounge, Retail Alcoholic Beverages, or Beer/Wine/Liquor Wholesaler.

Retail Tobacco Products Dealer Permit: you must check one or more of Pipes, Over the Counter, Vending Machine.

In 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.

Enter the FEIN Number, Business Telephone Number, Full Name of Applicant(s) (This is the name the license will be issued in), Department of State Document #, Business Name (D/B/A), Location Address (Street and Number) and City.

Enter the Zip Code, County and State, and the Mailing Address (Street or P.O. Box) with City, State and Zip Code.

Contact Person - This section is optional, see application instructions for details: Telephone Number, ext., E-Mail Address (Optional), Mailing Address (Street or P.O. Box), City, State and Zip Code.

Section 3, Related Party Personal Information, must be completed for each person directly connected with the business, unless they are a current licensee.

Enter 1. Business Name (D/B/A) and 2. Full Name of Individual, Social Security Number, Date of Birth, Race, Home Telephone Number, Sex, Height, Weight and Eye Color.

Enter Hair Color. 3. Are you a U.S. citizen? Yes No. If no, enter the immigration card number or passport number. Enter 4. Home Address (Street and Number), City, State and Zip Code.

5. Do you currently own or have an interest in any business selling alcoholic beverages, wholesale cigarette or tobacco products, or a bottle club? Yes No. If yes, provide Business Name (D/B/A), License Number and Location Address. The location address should include the city and state.

6. Have you had any type of alcoholic beverage, or bottle club license, or cigarette, or tobacco permit refused, revoked or suspended anywhere in the past 15 years? Yes No. If yes, provide Business Name (D/B/A), Date and Location Address.

7. Have you been convicted of a felony within the past 15 years? Yes No. If yes, provide Date, Location, Type of Offense and a Copy of the Arrest Disposition, as requested in the Application Requirements checklist.

8. Have you been convicted of an offense involving alcoholic beverages or tobacco products anywhere within the past 5 years? Yes No. If yes, provide Date, Location, Type of Offense and a Copy of the Arrest Disposition.

9. Have you been arrested or issued a notice to appear in any state of the United States or its territories within the past 15 years? Yes No. If yes, provide a Copy of the Arrest Disposition, with Date, Location and Type of Offense. Attach additional sheet if necessary.

The notarization statement has you swear under oath or affirmation under penalty of perjury, as provided for in Sections 559.791, 562.45 and 837.06, Florida Statutes. You swear that the parties are disclosed in the Disclosure of Interested Parties of this application. You also swear that the information is true and correct.

The applicant signs on APPLICANT SIGNATURE. Before the notary public: The statement was Sworn to and Subscribed OR Acknowledged before me, with the Commission Expires line and Notary Public.

Section 4, Description of Premises to be Licensed, is to be completed by the applicant: Business Name (D/B/A); 1. Is the proposed premises movable or able to be moved? Yes No; 2. Is there any access through the premises to any area over which you do not have dominion and control? Yes No.

3. Is the business located within a Specialty Center? Yes No. If yes, check the applicable statute: 561.20(2)(b)1, F.S. or 561.20(2)(b)2, F.S. 4. Are there any mobile vehicles used to sell or serve alcoholic beverages? Yes No. 5. Are there more than 3 separate rooms or enclosures with permanent bars or counters? Yes No.

Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which are contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar locations and any other specific areas which are part of the premises sought to be licensed.

Section 8, Disclosure of Interested Parties: failure to disclose an interest, direct or indirect, could result in denial, suspension and/or revocation of your license. You MUST list all persons and entities in the entire ownership structure.

SECTION 9 - AFFIDAVIT OF APPLICANT, NOTARIZATION REQUIRED: you swear or affirm that you are duly authorized to make the application and that the attached sketch is a true and correct representation of the entire area and premises to be licensed, and agree that the place of business, if licensed, may be inspected and searched without a search warrant.

You also swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and 837.06, Florida Statutes, that the information is true and that no other person or entity except as indicated herein has an interest in the alcoholic beverage license and/or tobacco permit.

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 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.

Ensure 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.

Department of Revenue clearance is required on applications for all new, transfer, change of location, and applications which change the licensee's name (61A-5.010 & 61A-5.056, FAC 2).

Health approval is required on all applications for consumption on the premises.

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. Your application will be considered incomplete without this active registration.

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) (checked November 2, 2026).

Submit your completed application and required fee(s) to your local district office.