Form DBPR ALU3 "License Maintenance/Status Change Form" - Florida

Form DBPR ALU3 Printable Pdf
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What Is Form DBPR ALU3?

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 July 1, 2017;
  • 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 printable version of Form DBPR ALU3 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 ALU3 "License Maintenance/Status Change Form" - Florida

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Page 1 of 4
State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
License Maintenance/Status Change Form
Form # DBPR ALU 3
APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your
application to ensure faster processing.
TRANSACTION
APPLICATION REQUIREMENTS
Complete Sections I, II and IV.
Address Change
Complete Sections I, III and IV.
Individuals must submit documentation supporting name
change. See Section III of Instructions.
No fee for an individual name change
Name Change
Pay $200 for a business name change. Make check payable
to the Florida Department of Business and Professional
Regulation.
 Complete Sections I and IV of this form.
Pay $100 fee if not within renewal period. Make check
Set License to Inactive
payable to the Department of Business and Professional
Regulation.
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
Instructions
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.
Application Instructions
a. Section I - Transaction Type
i.
Check only the applicable transaction(s) you are seeking.
ii.
If you would like to set your license in an inactive status, select the transaction type and
sign the affirmation statement in section V.
.
b
Section II – Address Change
i.
This transaction allows a business or individual to change their current mailing and/or
physical address.
ii. Choosing this transaction will change the address on file with the Department but it will
not issue an updated license with the new address information.
iii. There is no fee for an address change.
c. Section III – Name Change
i.
This transaction allows a business or individual to change their registered name with the
Department of Business and Professional Regulation.
ii.
For a business name change: The Division of Corporations Document Numbers for the
current and new businesses must be the same for corporate name changes and adding
fictitious names. For conversions from corporations to LLCs and conversions from LLCs
to corporations, the Certificate of Conversion must reflect the change. All other corporate
changes require you to submit an application to transfer to a new business entity.
iii.
Check the box attesting that you have the required insurance in the new name.
iv.
For a business name change: submit a rider to the existing bond showing the new name.
DBPR ALU 3– Maintenance Form/Status Change
2017 July
Incorporated by Rule: 61-35.003
Page 1 of 4
State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
License Maintenance/Status Change Form
Form # DBPR ALU 3
APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your
application to ensure faster processing.
TRANSACTION
APPLICATION REQUIREMENTS
Complete Sections I, II and IV.
Address Change
Complete Sections I, III and IV.
Individuals must submit documentation supporting name
change. See Section III of Instructions.
No fee for an individual name change
Name Change
Pay $200 for a business name change. Make check payable
to the Florida Department of Business and Professional
Regulation.
 Complete Sections I and IV of this form.
Pay $100 fee if not within renewal period. Make check
Set License to Inactive
payable to the Department of Business and Professional
Regulation.
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
Instructions
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.
Application Instructions
a. Section I - Transaction Type
i.
Check only the applicable transaction(s) you are seeking.
ii.
If you would like to set your license in an inactive status, select the transaction type and
sign the affirmation statement in section V.
.
b
Section II – Address Change
i.
This transaction allows a business or individual to change their current mailing and/or
physical address.
ii. Choosing this transaction will change the address on file with the Department but it will
not issue an updated license with the new address information.
iii. There is no fee for an address change.
c. Section III – Name Change
i.
This transaction allows a business or individual to change their registered name with the
Department of Business and Professional Regulation.
ii.
For a business name change: The Division of Corporations Document Numbers for the
current and new businesses must be the same for corporate name changes and adding
fictitious names. For conversions from corporations to LLCs and conversions from LLCs
to corporations, the Certificate of Conversion must reflect the change. All other corporate
changes require you to submit an application to transfer to a new business entity.
iii.
Check the box attesting that you have the required insurance in the new name.
iv.
For a business name change: submit a rider to the existing bond showing the new name.
DBPR ALU 3– Maintenance Form/Status Change
2017 July
Incorporated by Rule: 61-35.003
Page 2 of 4
v.
For an individual name change: a change of name requires submitting supporting legal
documentation of name change (e.g. marriage license, court documents showing name
change, divorce decree, etc).
vii.
There is no fee for an individual name change.
viii.
The fee for a business name change is $200. Make your check or money order payable
to: Department of Business and Professional Regulation (DBPR).
g. Section IV - Affirmation by Written Declaration
i.
The applicant must read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR ALU 3– Maintenance Form/Status Change
2017 July
Incorporated by Rule: 61-35.003
Page 3 of 4
State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
License Maintenance/Status Change Form
Form # DBPR ALU 3
Section I – Transaction Types
CHECK ONLY ONE OF THE APPLICATION TYPES
(Multiple transactions can be completed on this form)
Address Change
[9006]
(Complete Sections I, II and V)
Name Change –
[8001]
(Complete Sections I, III, and V)
Set License to Inactive –
[4020]
(Complete Sections I and V)
APPLICATION TYPE
Individual
Business
License Number:
License Number:
CONTACT INFORMATION
Name:
Phone Number: (
)
-
Email Address:
Section II – Address Change
NEW PHYSICAL ADDRESS
Street Address
City
State
County
Country
NEW MAILING ADDRESS
Street Address
City
State
County
Country
DBPR ALU 3– Maintenance Form/Status Change
2017 July
Incorporated by Rule: 61-35.003
Page 4 of 4
Section III–Name Change
NAME CHANGE INFORMATION
The Division of Corporations Document
If this transaction is for changing the company’s name:
Numbers for the current and new businesses must be the same for corporate name changes and
adding fictitious names. For conversions from corporations to LLCs and conversions from LLCs
to corporations, the Certificate of Conversion must reflect the change. All other corporate changes
require you to submit an application to transfer to a new business entity.
You must submit a rider to the existing bond showing the new name.
If this transaction is for changing a personal name, the individual must submit supporting legal
documentation of the name change with this completed form (e.g. marriage license, court documents
showing name change, divorce decree, etc).
Company/Individual Name (previous)
Company/Individual Name (new)
Minimum amounts required for insurance:
Public Liability Insurance $100/000/$300,000 and
Property Damage Insurance $100,000/$300,000
Have you obtained public liability and property damage insurance in the amounts as specified above in
the new name?
 Yes
 No
Have you obtained, prior to contracting, workers’ compensation or an appropriate exemption as provided
in Section 440.05, Florida Statutes, and if not, do you attest that you will obtain an exemption within 30
days after your license is issued in new name?
 Yes
 No
Section IV – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
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 ALU 3– Maintenance Form/Status Change
2017 July
Incorporated by Rule: 61-35.003
Florida Department of Business & Professional Regulation Florida Legal Forms United States Legal Forms

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