Form FDACS-03583 "Lp Gas Category VI Miscellaneous Operator License Application" - Florida

What Is Form FDACS-03583?

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 August 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-03583 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-03583 "Lp Gas Category VI Miscellaneous Operator License Application" - Florida

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Florida Department of Agriculture and Consumer Services
Make Check or Money Order
Division of Consumer Services
payable to FDACS and remit with
form to:
LP GAS CATEGORY VI
MISCELLANEOUS OPERATOR LICENSE APPLICATION
FDACS
P.O. Box 6700
ADAM H. PUTNAM
Chapter 527, Florida Statutes
Tallahassee, Florida 32314-6700
COMMISSIONER
Select one:
____ 1 year license ($200)
____ 2 year license ($400)
____ 3 year license ($600)
TO APPLY: Fill this form out completely (PRINT OR TYPE) and return it with all attachments, including the license
application fee, to the Bureau of Compliance [(850) 921-1600] at the address in the upper right-hand corner.
APPLICATION IS HEREBY MADE FOR THE FOLLOWING LP GAS LICENSE (SELECT ONE):
Manufacturer of LP Gas Appliances and Equipment
Pipeline System Operator (Please attach names
and addresses of systems on a separate sheet)
Requalifier of Cylinders
Fabricator, Repairer and Tester of Vehicles and
Cargo Tanks
Business Name or DBA
:
(Name to be printed on license)
Physical Address
:
Mailing Address
:
(Address of business to be licensed)
(if different)
City, State, Zip, County:
City, State, Zip, County:
Telephone:
Email Address:
(
)
Company Name or Corporation:
Company Mailing Address:
City, State, Zip:
PRINT NAME OF OWNER OR MANAGER:
NAME OF PERSON PREPARING APPLICATION:
SIGNATURE OF OWNER OR MANAGER:
PREPARER’S PHONE NO:
PREPARER’S EMAIL ADDRESS:
DATE OF APPLICATION:
PREPARER’S TITLE OR OFFICE HELD:
PROOF OF INSURANCE OR BOND MUST BE ENCLOSED WITH YOUR APPLICATION AND FEE. Pursuant to Section
527.04, F.S., minimum insurance of $1,000,000 bodily injury liability and property damage liability covering the products and
operations of the business is required.
Org Code: 42 10 06 25 000
F&A Use Only
EO: A2
Object Code: 002102
FDACS-03583 08/18
Florida Department of Agriculture and Consumer Services
Make Check or Money Order
Division of Consumer Services
payable to FDACS and remit with
form to:
LP GAS CATEGORY VI
MISCELLANEOUS OPERATOR LICENSE APPLICATION
FDACS
P.O. Box 6700
ADAM H. PUTNAM
Chapter 527, Florida Statutes
Tallahassee, Florida 32314-6700
COMMISSIONER
Select one:
____ 1 year license ($200)
____ 2 year license ($400)
____ 3 year license ($600)
TO APPLY: Fill this form out completely (PRINT OR TYPE) and return it with all attachments, including the license
application fee, to the Bureau of Compliance [(850) 921-1600] at the address in the upper right-hand corner.
APPLICATION IS HEREBY MADE FOR THE FOLLOWING LP GAS LICENSE (SELECT ONE):
Manufacturer of LP Gas Appliances and Equipment
Pipeline System Operator (Please attach names
and addresses of systems on a separate sheet)
Requalifier of Cylinders
Fabricator, Repairer and Tester of Vehicles and
Cargo Tanks
Business Name or DBA
:
(Name to be printed on license)
Physical Address
:
Mailing Address
:
(Address of business to be licensed)
(if different)
City, State, Zip, County:
City, State, Zip, County:
Telephone:
Email Address:
(
)
Company Name or Corporation:
Company Mailing Address:
City, State, Zip:
PRINT NAME OF OWNER OR MANAGER:
NAME OF PERSON PREPARING APPLICATION:
SIGNATURE OF OWNER OR MANAGER:
PREPARER’S PHONE NO:
PREPARER’S EMAIL ADDRESS:
DATE OF APPLICATION:
PREPARER’S TITLE OR OFFICE HELD:
PROOF OF INSURANCE OR BOND MUST BE ENCLOSED WITH YOUR APPLICATION AND FEE. Pursuant to Section
527.04, F.S., minimum insurance of $1,000,000 bodily injury liability and property damage liability covering the products and
operations of the business is required.
Org Code: 42 10 06 25 000
F&A Use Only
EO: A2
Object Code: 002102
FDACS-03583 08/18