Form FDACS-03581 "Lp Gas Category IV Dealer in Appliances and Equipment License Application" - Florida

What Is Form FDACS-03581?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-03581 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-03581 "Lp Gas Category IV Dealer in Appliances and Equipment License Application" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Make Check or Money Order
payable to FDACS and remit
with form to:
LP GAS CATEGORY IV
DEALER IN APPLIANCES AND EQUIPMENT
FDACS
LICENSE APPLICATION
P.O. Box 6700
NICOLE “NIKKI” FRIED
Tallahassee, Florida 32314-6700
COMMISSIONER
Chapter 5 27, Florida Statut
es
Rule 5J-20.004, Florida Administrative Code
Select one:
____ Initial Application
____ License Renewal LA # ________
Select one:
____ 1-year license ($65 each)
____ 2-year license ($130 each)
____ 3-year license ($195 each)
INSTRUCTIONS: Complete this form (PRINT OR TYPE), and return it with all attachments and license fee(s) to the Bureau
of Compliance [(850) 921-1600] at the address in the upper right-hand corner. If renewing one or more licenses, verify and
update prepopulated information as necessary.
Business Name or DBA
:
Company Name or Corporation:
(Name to be printed on license)
Physical Address
:
Company Mailing Address
:
(Address of Business to be licensed)
(if different)
City, State, Zip, County:
City, State, Zip, County:
Telephone:
Email Address:
(
)
Has the owner/applicant been convicted or pled nolo contendere to a felony as defined in Rule 5J-20.005, F.A.C.,
within the last five years?
NO
YES
If yes, please attach additional pages and explain.
PRINT NAME OF OWNER/APPLICANT:
NAME OF PERSON PREPARING APPLICATION:
SIGNATURE OF OWNER/APPLICANT:
PREPARER’S PHONE
PREPARER’S EMAIL ADDRESS:
NO:
(
)
DATE OF APPLICATION:
PREPARER’S TITLE OR OFFICE HELD:
F&A Use Only
Org Code: 42 10 06 25 000
EO: A2
Object Code: 002102
FDACS-03581 Rev. 09/20
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Make Check or Money Order
payable to FDACS and remit
with form to:
LP GAS CATEGORY IV
DEALER IN APPLIANCES AND EQUIPMENT
FDACS
LICENSE APPLICATION
P.O. Box 6700
NICOLE “NIKKI” FRIED
Tallahassee, Florida 32314-6700
COMMISSIONER
Chapter 5 27, Florida Statut
es
Rule 5J-20.004, Florida Administrative Code
Select one:
____ Initial Application
____ License Renewal LA # ________
Select one:
____ 1-year license ($65 each)
____ 2-year license ($130 each)
____ 3-year license ($195 each)
INSTRUCTIONS: Complete this form (PRINT OR TYPE), and return it with all attachments and license fee(s) to the Bureau
of Compliance [(850) 921-1600] at the address in the upper right-hand corner. If renewing one or more licenses, verify and
update prepopulated information as necessary.
Business Name or DBA
:
Company Name or Corporation:
(Name to be printed on license)
Physical Address
:
Company Mailing Address
:
(Address of Business to be licensed)
(if different)
City, State, Zip, County:
City, State, Zip, County:
Telephone:
Email Address:
(
)
Has the owner/applicant been convicted or pled nolo contendere to a felony as defined in Rule 5J-20.005, F.A.C.,
within the last five years?
NO
YES
If yes, please attach additional pages and explain.
PRINT NAME OF OWNER/APPLICANT:
NAME OF PERSON PREPARING APPLICATION:
SIGNATURE OF OWNER/APPLICANT:
PREPARER’S PHONE
PREPARER’S EMAIL ADDRESS:
NO:
(
)
DATE OF APPLICATION:
PREPARER’S TITLE OR OFFICE HELD:
F&A Use Only
Org Code: 42 10 06 25 000
EO: A2
Object Code: 002102
FDACS-03581 Rev. 09/20