Form DBPR AR4 "Architect or Architect Business Seeking Licensure as Interior Designer" - Florida

This version of the form is not currently in use and is provided for reference only.
Download this version of Form DBPR AR4 for the current year.

What Is Form DBPR AR4?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - 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, 2012;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • 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 DBPR AR4 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR AR4 "Architect or Architect Business Seeking Licensure as Interior Designer" - Florida

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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Architect or Architect Business Seeking Licensure as Interior Designer
Form # DBPR AR 4
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Submit the non-refundable fee of $30.00. Make the check payable to the
Architect Seeking
Florida Department of Business and Professional Regulation.
Licensure as Interior
 If you are applying as an individual complete Sections I-II and IV-V.
Designer
Architect Business
 There is no application fee.
Seeking Licensure as
 Complete all sections of this application.
Interior Design
Business
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
General Information –
Applicants must hold a current Florida architect license or architecture certificate of authorization (aka
business license) in good standing to obtain an interior design license through this application method.
The applicant business entity’s qualifier may qualify more than one business entity but can be the
responsible supervisor of only one location unless both business entities are physically located at the
same address.
Application Instructions (by section):
a. Section I- Application Type
Check only the applicable transaction you are seeking.
b. Section II- Applicant Information
i.
Fill out each section completely. This section must be completed by the licensed
architect.
ii.
In the Full Legal Name section provide your full legal name as it appears on your license.
Do not use any nicknames or initials.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
c. Section III- Business Information
i.
Fill out each section completely.
ii.
This section must only be completed if applying for a business license.
iii.
Provide the business name or doing business as (fictitious name) for the business.
Provide the federal tax identification number.
iv.
Identify the principal officer position of the business qualifier as listed with the Florida
Department of State, Division of Corporations. Provide the qualifiers name and license
number. Identify the responsible supervisor’s name and license number if that person is
different than the qualifier.
v.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Architect or Architect Business Seeking Licensure as Interior Designer
Form # DBPR AR 4
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Submit the non-refundable fee of $30.00. Make the check payable to the
Architect Seeking
Florida Department of Business and Professional Regulation.
Licensure as Interior
 If you are applying as an individual complete Sections I-II and IV-V.
Designer
Architect Business
 There is no application fee.
Seeking Licensure as
 Complete all sections of this application.
Interior Design
Business
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
General Information –
Applicants must hold a current Florida architect license or architecture certificate of authorization (aka
business license) in good standing to obtain an interior design license through this application method.
The applicant business entity’s qualifier may qualify more than one business entity but can be the
responsible supervisor of only one location unless both business entities are physically located at the
same address.
Application Instructions (by section):
a. Section I- Application Type
Check only the applicable transaction you are seeking.
b. Section II- Applicant Information
i.
Fill out each section completely. This section must be completed by the licensed
architect.
ii.
In the Full Legal Name section provide your full legal name as it appears on your license.
Do not use any nicknames or initials.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
c. Section III- Business Information
i.
Fill out each section completely.
ii.
This section must only be completed if applying for a business license.
iii.
Provide the business name or doing business as (fictitious name) for the business.
Provide the federal tax identification number.
iv.
Identify the principal officer position of the business qualifier as listed with the Florida
Department of State, Division of Corporations. Provide the qualifiers name and license
number. Identify the responsible supervisor’s name and license number if that person is
different than the qualifier.
v.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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vi.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
d. Section IV- Background Questions
i.
Answer background questions one through three.
ii.
If you answer “yes” to any of the background questions, provide details or attach
documentation as needed.
e. Section V- Affirmation by Written Declaration
i.
This must be signed by the licensed architect or the qualifying licensed architect if
applying for the business license.
ii.
Please read, sign and date the affirmation by written declaration.
iii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Architect or Architect Business Seeking Licensure as Interior Designer
Form # DBPR AR 4
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I- Application Type
CHECK APPLICATION TYPE
 Architect Seeking Interior Design License [0203/1032]
 Architect Business Seeking Interior Design Business License [0204/1034]
Florida Architect or Florida Architect Business License Number
Section II – Applicant Information
APPLICANT INFORMATION
Social Security Number*
FULL LEGAL NAME
Last/Surname
First
Middle
Suffix
Birth Date (MM/DD/YYYY)
Gender
/
/
 Male  Female
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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Section III – Business Information (to be completed only if applying for a business license)
BUSINESS TO BE QUALIFIED
(Business applicant’s must have a principal officer who qualifies the business)
Business Name
Doing Business As (D/B/A)
Federal Employer ID Number (FEID)
Identify the principal officer position of the business qualifier as listed with the Florida Department of
State, Division of Corporations
Qualifier Name
License Number
Is the qualifier the responsible supervisor in control of the Interior Design Business?  YES  NO
If no, indentify a Florida licensed interior designer or architect in responsible supervisory control of the
business location?
Responsible Supervisor Name
License Number
BUSINESS MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code
County (if Florida address)
Country
BUSINESS CONTACT INFORMATION (IF DIFFERENT THAN APPLICANT INFORMATION)
Contact Name
Phone Number of Contact
E-Mail Address of Contact
BUSINESS LOCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
Section IV - Background Questions
BACKGROUND INFORMATION
1. Have you ever been a defendant in a civil case involving the practice of interior
 Yes
design?
 No
2. Have you ever been a defendant in a criminal action case?
 Yes
 No
3. Have you ever been a plaintiff in a civil suit involving the practice of interior
 Yes
design?
 No
If you answered “yes” to any of the above questions, please provide details.
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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Section V – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
(This must be signed by the licensed architect or the qualifying licensed architect if applying for
the business license)
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature
Date
Print Name
DBPR AR 4 – Architect or Architect Business Seeking Licensure as ID Eff. Date 2012 Oct Incorporated by Rule: 61-35.002
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