Form DBPR BAR10 "Barbershop Change of Status Transactions" - Florida

What Is Form DBPR BAR10?

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 May 29, 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 BAR10 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 BAR10 "Barbershop Change of Status Transactions" - Florida

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1 of 3
State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Barbershop Change of Status Transactions
Form # DBPR BAR 10
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Complete Sections II and V of this form.
Request Duplicate
Pay $25 fee. (Make check payable to the Department of Business and
License
Professional Regulation.)
Submit police report, if applicable.
Complete Sections III and V of this form.
Barbershop Mailing
No fee.
Address Change
Complete Sections IV and V of this form.
Close Barbershop
No fee.
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.
1. Application Instructions (by section)
a. Section I
i.
Check only the applicable transaction(s) you are seeking.
b. Sections II through IV
i.
Fill out each section completely, as applicable.
c. Section VI
i.
Please 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.
2. Other Information
a. For a barbershop location address, name or ownership change, a new barbershop
application must be submitted prior to changing locations.
DBPR BAR 10 Barbershop Change of Status Transactions
Incorporated by Rule: 61-35.006
May 29, 2012
1 of 3
State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Barbershop Change of Status Transactions
Form # DBPR BAR 10
TRANSACTION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
form to ensure faster processing.
TRANSACTION
TRANSACTION REQUIREMENTS
Complete Sections II and V of this form.
Request Duplicate
Pay $25 fee. (Make check payable to the Department of Business and
License
Professional Regulation.)
Submit police report, if applicable.
Complete Sections III and V of this form.
Barbershop Mailing
No fee.
Address Change
Complete Sections IV and V of this form.
Close Barbershop
No fee.
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.
1. Application Instructions (by section)
a. Section I
i.
Check only the applicable transaction(s) you are seeking.
b. Sections II through IV
i.
Fill out each section completely, as applicable.
c. Section VI
i.
Please 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.
2. Other Information
a. For a barbershop location address, name or ownership change, a new barbershop
application must be submitted prior to changing locations.
DBPR BAR 10 Barbershop Change of Status Transactions
Incorporated by Rule: 61-35.006
May 29, 2012
2 of 3
State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Barbershop Change of Status Transactions
Form # DBPR BAR 10
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 ONE OF THE TRANSACTION TYPES
(Use multiple forms if more than one transaction is applicable)
Duplicate License Request [8001]
Complete Sections II and V.
Barbershop Mailing Address Change [9006]
Complete Sections III and V.
Close Barbershop [8080]
Complete Sections IV and V.
Contact Name:
Email Address:
Phone Number:
Section II – Request Duplicate License
DUPLICATE LICENSE INFORMATION
Barbershop Name
Barbershop License Number
Please indicate reason for duplicate license request
 Lost
 Destroyed
 Stolen – no charge (requires submission of police report)
 Change of mailing address
Signature of Authorized Representative
Date
Name of Authorized Representative
Section III – Barbershop Mailing Address Change
LICENSEE INFORMATION
Barbershop Name
Barbershop License Number
NEW MAILING ADDRESS
Street Address
City
State
Zip Code (+4 Optional)
County
Country
Signature of Authorized Representative
Date
Print Name of Authorized Representative
DBPR BAR 10 Barbershop Change of Status Transactions
Incorporated by Rule: 61-35.006
May 29, 2012
3 of 3
Section IV – Close Barbershop
BARBERSHOP INFORMATION
Barbershop Name
Barbershop License Number
Signature of Authorized Representative
Date
Print Name of Authorized Representative
Section V – 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 BAR 10 Barbershop Change of Status Transactions
Incorporated by Rule: 61-35.006
May 29, 2012
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