Form FDACS-10991 "Military Fee Waiver Request" - Florida

What Is Form FDACS-10991?

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 October 1, 2018;
  • 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-10991 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-10991 "Military Fee Waiver Request" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Please return completed request,
supporting documentation and
MILITARY FEE WAIVER REQUEST
Registration Application to:
Sections 472.015(3)(b), 472.016, 501.015(2), 501.605(5)(b), 501.607(2)(b),
FDACS
501.609, 507.03(3)(b), (c), 527.02(3)(b), (c), 539.001(3)(c), (g), 559.904(3)(b),
Bureau of Compliance
(c), 559.928(2)(c), (d), Florida Statutes
NICOLE "NIKKI" FRIED
P.O. Box 6700
Rule 5J-26.001, Florida Administrative Code
Tallahassee, FL 32314-6700
COMMISSIONER
1-800-HELP-FLA (435-7352) • (850) 410-3800
www.FDACS.gov • (850) 410-3804 Fax
Certain individuals may apply for an initial registration fee waiver or a renewal registration fee waiver in the licensure areas
listed below. Please indicate which type of waiver you are requesting and the program area in which you are requesting
the waiver. In addition to completing this fee waiver request, applicants are required to complete the registration
application of the program area in which they are requesting licensure. The registration application, waiver request and
supporting documentation should be submitted to the department at the same time. All documents and attachments
submitted with this application may be subject to public review pursuant to Chapter 119, F.S. PLEASE TYPE OR PRINT.
Waiver of Initial Fee
Waiver of Renewal Fee
Board of Professional Surveyors and Mappers
(ss. 472.015(3)(b), 472.016, F.S.)
Florida Telemarketing Act – Licensure of commercial telephone sellers
(ss. 501.605(5)(b), 501.609, F.S.)
Florida Telemarketing Act – Licensure of salespersons
(ss. 501.607(2)(b), 501.609, F.S.)
Florida Telemarketing Act – Licensure of substance abuse marketing service providers
(ss. 501.605(5)(b), 501.609, F.S.)
Health Studios
(s. 501.015(2), F.S.)
Household Moving Services
(ss. 507.03(3)(b), (c), F.S.)
Pawnbroking
(ss. 539.001(3)(c), (g), F.S.)
Repair of Motor Vehicles
(ss. 559.904(3)(b), (c), F.S.)
Sale of Liquefied Petroleum Gas
(ss. 527.02(3)(b), (c), F.S.)
Seller of Travel
(ss. 559.928(2)(c), (d), F.S.)
Applicant Information
Name of Business or Individual
(If a business, state the legal name of the entity as registered with the Florida Department of State, Division of
:
Corporations)
Fictitious (DBA) Name
:
(if applicable)
Mailing Address
:
(include APT or SUITE #)
City:
State:
Zip Code:
-
Telephone Number:
Fax Number:
(
)
-
(
)
-
Email Address:
Name of military service member:
Date of the veteran’s honorable discharge:
FDACS-10991 Rev. 10/18
Page 1 of 3
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Please return completed request,
supporting documentation and
MILITARY FEE WAIVER REQUEST
Registration Application to:
Sections 472.015(3)(b), 472.016, 501.015(2), 501.605(5)(b), 501.607(2)(b),
FDACS
501.609, 507.03(3)(b), (c), 527.02(3)(b), (c), 539.001(3)(c), (g), 559.904(3)(b),
Bureau of Compliance
(c), 559.928(2)(c), (d), Florida Statutes
NICOLE "NIKKI" FRIED
P.O. Box 6700
Rule 5J-26.001, Florida Administrative Code
Tallahassee, FL 32314-6700
COMMISSIONER
1-800-HELP-FLA (435-7352) • (850) 410-3800
www.FDACS.gov • (850) 410-3804 Fax
Certain individuals may apply for an initial registration fee waiver or a renewal registration fee waiver in the licensure areas
listed below. Please indicate which type of waiver you are requesting and the program area in which you are requesting
the waiver. In addition to completing this fee waiver request, applicants are required to complete the registration
application of the program area in which they are requesting licensure. The registration application, waiver request and
supporting documentation should be submitted to the department at the same time. All documents and attachments
submitted with this application may be subject to public review pursuant to Chapter 119, F.S. PLEASE TYPE OR PRINT.
Waiver of Initial Fee
Waiver of Renewal Fee
Board of Professional Surveyors and Mappers
(ss. 472.015(3)(b), 472.016, F.S.)
Florida Telemarketing Act – Licensure of commercial telephone sellers
(ss. 501.605(5)(b), 501.609, F.S.)
Florida Telemarketing Act – Licensure of salespersons
(ss. 501.607(2)(b), 501.609, F.S.)
Florida Telemarketing Act – Licensure of substance abuse marketing service providers
(ss. 501.605(5)(b), 501.609, F.S.)
Health Studios
(s. 501.015(2), F.S.)
Household Moving Services
(ss. 507.03(3)(b), (c), F.S.)
Pawnbroking
(ss. 539.001(3)(c), (g), F.S.)
Repair of Motor Vehicles
(ss. 559.904(3)(b), (c), F.S.)
Sale of Liquefied Petroleum Gas
(ss. 527.02(3)(b), (c), F.S.)
Seller of Travel
(ss. 559.928(2)(c), (d), F.S.)
Applicant Information
Name of Business or Individual
(If a business, state the legal name of the entity as registered with the Florida Department of State, Division of
:
Corporations)
Fictitious (DBA) Name
:
(if applicable)
Mailing Address
:
(include APT or SUITE #)
City:
State:
Zip Code:
-
Telephone Number:
Fax Number:
(
)
-
(
)
-
Email Address:
Name of military service member:
Date of the veteran’s honorable discharge:
FDACS-10991 Rev. 10/18
Page 1 of 3
Waiver of Initial Fee Requirements
(Please check one and attach the required documentation)
The following persons are eligible for a waiver of the application fee associated with each initial license or registration.
Please indicate the waiver you are requesting.
I AM AN HONORABLY DISCHARGED VETERAN OF THE UNITED STATES ARMED FORCES OR NATIONAL GUARD. To qualify
for the waiver, the following documentation is required:
A copy of your DD Form 214 or NGB-22, as issued by the United States Department of Defense, or another acceptable
form of identification as specified by the Department of Veterans’ Affairs.
I AM OR WAS THE SPOUSE/SURVIVING SPOUSE OF AN HONORABLY DISCHARGED VETERAN (AT THE TIME OF
DISCHARGE) OF THE UNITED STATES ARMED FORCES OR NATIONAL GUARD. To qualify for the waiver, the following
documentation is required:
A copy of the veteran’s DD Form 214 or NGB-22, as issued by the United States Department of Defense, or another
acceptable form of identification as specified by the Department of Veterans’ Affairs; and
A copy of a valid marriage license or certificate verifying that you were lawfully married to the veteran at the time of
his/her discharge.
I AM A CURRENT MEMBER OR THE SPOUSE OF A CURRENT MEMBER OF THE UNITED STATES ARMED FORCES OR
NATIONAL GUARD WHO HAS SERVED ON ACTIVE DUTY. To qualify for the waiver, the following documentation is required:
A copy of your, or your spouse’s military orders, as issued by the United States Department of Defense, or another
acceptable form of identification as specified by the Department of Veterans’ Affairs; and if applicable
A copy of a valid marriage license or certificate verifying that you are lawfully married to the military service member.
I AM THE SURVIVING SPOUSE OF A MEMBER OF THE UNITED STATES ARMED FORCES OR NATIONAL GUARD WHO DIED
ON ACTIVE DUTY. To qualify for the waiver, the following documentation is required:
A copy of the military service member’s DD Form 214 or NGB-22, as issued by the United States Department of Defense,
or another acceptable form of identification as specified by the Department of Veterans’ Affairs; and
A copy of a valid marriage license or certificate verifying that you were lawfully married to the military service member at
the time of his/her death while on active duty.
I AM A CURRENT MEMBER, OR AN HONORABLY DISCHARGED VETERAN, OR SPOUSE/SURVIVING SPOUSE OF AN
HONORABLY DISCHARGED VETERAN AND HOLD MAJORITY OWNERSHIP IN THE BUSINESS ENTITY. To qualify for the
waiver, the following documentation is required:
Proof that a veteran or the spouse/surviving spouse of a veteran holds a majority ownership in the business;
The name, address and telephone number of such majority owner;
A copy of the veteran’s DD Form 214 or NGB-22, as issued by the United States Department of Defense, or another
acceptable form of identification as specified by the Department of Veterans’ Affairs; and if applicable
A copy of a valid marriage license or certificate verifying that you were lawfully married to the veteran at the time of
his/her discharge.
FDACS-10991 Rev. 10/18
Page 2 of 3
Waiver of Renewal Fee Requirements
(Please check one and attach the required documentation)
The following persons are eligible for a waiver of the application fee associated with the renewal of a license or
registration. Please indicate which waiver you are requesting.
I AM A MEMBER, OR AN HONORABLY DISCHARGED VETERAN OF THE UNITED STATES ARMED FORCES OR NATIONAL
GUARD. To qualify for the waiver, the following documentation is required:
A copy of your military orders, as issued by the United States Department of Defense, or another acceptable form of
identification as specified by the Department of Veterans’ Affairs; or if applicable
A copy of your DD Form 214 or NGB-22, as issued by the United States Department of Defense, or another acceptable
form of identification as specified by the Department of Veterans’ Affairs that proves you served on active duty within the
2 years preceding the renewal date of your license.
I AM THE SPOUSE OF A MEMBER OF THE UNITED STATES ARMED FORCES OR NATIONAL GUARD. To qualify for the waiver,
the following documentation is required:
A copy of your spouse’s military orders, as issued by the United States Department of Defense, or another acceptable
form of identification as specified by the Department of Veterans’ Affairs.
A copy of a valid marriage license or certificate verifying that you are lawfully married to the active military member.
I WAS THE SPOUSE OF A MEMBER OF THE UNITED STATES ARMED FORCES OR NATIONAL GUARD WHO WAS SERVING
ON ACTIVE DUTY AT THE TIME OF DEATH AND DIED WITHIN THE 2 YEARS PRECEDING THE RENEWAL DATE OF MY
LICENSE. To qualify for the waiver, the following documentation is required:
A copy of the military service member’s DD Form 214 or NGB-22, as issued by the United States Department of Defense,
or another acceptable form of identification as specified by the Department of Veterans’ Affairs
A copy of a valid marriage license or certificate verifying that you were lawfully married to the military service member at
the time of his/her death.
Certification
I declare under penalty of perjury that the foregoing is true and correct. I understand that this request will not be considered unless all
required documentation has been provided and submitted along with a completed program registration application.
Signature
/
/
Print Name
Month
Day
Year
FDACS-10991 Rev. 10/18
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