Form DBPR TA-2 "Application for Change of Owner or Operator" - Florida

What Is Form DBPR TA-2?

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 December 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 TA-2 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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State of Florida
Department of Business and Professional Regulation
Division of Professions: Talent Agencies
Application for Change of Owner or Operator
Form # DBPR TA-2
APPLICATION CHECKLIST – IMPORTANT – Submit items on the checklist below with your
application to ensure faster processing. Always keep a copy of your application and any
supporting documents submitted to the Department.
APPLICATION
APPLICATION REQUIREMENTS
 Fees:
-
$300 fee for change of owner.
-
$150 fee for change of operator.
-
$450 fee for change of owner and operator.
-
Make check payable to the Florida Department of Business and
Application for
Professional Regulation.
 Completed form DBPR TA-2 Application for Change of Owner or Operator.
Change of Owner or
 Electronic fingerprints for all new owners and/or operators.
Operator
 If changing owner, provide five (5) moral character affidavits for new
owner.
 If changing operator, provide operator work experience form for new
operator.
 Supporting legal documentation (if applicable). See Section 2(f) of
Instructions.
Removal of Owner
 No fee.
Only
 Completed form DBPR TA-2 Application for Change of Owner or Operator.
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
This application is for a licensed Talent Agency whose operator and / or owner only has changed. The
name and location of the Talent Agency must remain the same. If the name and or / location has also
changed, please complete initial application for licensure packet TA-1.
1. General Requirements for Licensure as a Talent Agency
a. Fingerprints:
i.
Each new owner of the talent agency and each new operator of the talent agency must
submit electronic fingerprints.
ii.
Electronic fingerprinting is available at various convenient sites throughout the state. See
http://www.myfloridalicense.com/dbpr/servop/testing/documents/finger_faq.pdf
for more
information.
iii.
If the talent agency is owned by a corporation, the applicant must submit the electronic
fingerprints of the new principle officer signing the application form and surety bond,
along with the electronic fingerprints of the operator of the talent agency.
(1)
An updated bond form with the signature of the new principle officer is required if the
principle officer signing the original bond form has changed.
b. Experience: The operator of the talent agency must show at least one (1) year of direct
experience or similar experience in the talent agency business or as a subagent, casting
director, producer, director, advertising agency, talent coordinator, or musical booking agent.
c. Character Affidavits: Provide five (5) moral character affidavits or if a corporation, affidavits
that state that the corporation has a reputation for fair dealings. Affidavits cannot be accepted
from a family member or an artist as defined in Chapter 468, Part VII, Florida Statutes. The
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003
State of Florida
Department of Business and Professional Regulation
Division of Professions: Talent Agencies
Application for Change of Owner or Operator
Form # DBPR TA-2
APPLICATION CHECKLIST – IMPORTANT – Submit items on the checklist below with your
application to ensure faster processing. Always keep a copy of your application and any
supporting documents submitted to the Department.
APPLICATION
APPLICATION REQUIREMENTS
 Fees:
-
$300 fee for change of owner.
-
$150 fee for change of operator.
-
$450 fee for change of owner and operator.
-
Make check payable to the Florida Department of Business and
Application for
Professional Regulation.
 Completed form DBPR TA-2 Application for Change of Owner or Operator.
Change of Owner or
 Electronic fingerprints for all new owners and/or operators.
Operator
 If changing owner, provide five (5) moral character affidavits for new
owner.
 If changing operator, provide operator work experience form for new
operator.
 Supporting legal documentation (if applicable). See Section 2(f) of
Instructions.
Removal of Owner
 No fee.
Only
 Completed form DBPR TA-2 Application for Change of Owner or Operator.
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
This application is for a licensed Talent Agency whose operator and / or owner only has changed. The
name and location of the Talent Agency must remain the same. If the name and or / location has also
changed, please complete initial application for licensure packet TA-1.
1. General Requirements for Licensure as a Talent Agency
a. Fingerprints:
i.
Each new owner of the talent agency and each new operator of the talent agency must
submit electronic fingerprints.
ii.
Electronic fingerprinting is available at various convenient sites throughout the state. See
http://www.myfloridalicense.com/dbpr/servop/testing/documents/finger_faq.pdf
for more
information.
iii.
If the talent agency is owned by a corporation, the applicant must submit the electronic
fingerprints of the new principle officer signing the application form and surety bond,
along with the electronic fingerprints of the operator of the talent agency.
(1)
An updated bond form with the signature of the new principle officer is required if the
principle officer signing the original bond form has changed.
b. Experience: The operator of the talent agency must show at least one (1) year of direct
experience or similar experience in the talent agency business or as a subagent, casting
director, producer, director, advertising agency, talent coordinator, or musical booking agent.
c. Character Affidavits: Provide five (5) moral character affidavits or if a corporation, affidavits
that state that the corporation has a reputation for fair dealings. Affidavits cannot be accepted
from a family member or an artist as defined in Chapter 468, Part VII, Florida Statutes. The
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003
affidavits must be completed by a person who has known or been associated with the
applicant for at least three (3) years.
2. Application Instructions (by section)
a. Section I- Application Type
i.
Select the application type for which you are applying.
b. Section II- Business Information
i.
Complete this section entirely.
ii.
Provide the name of the Talent Agency as it is registered with the Florida Department of
State’s Division of Corporations.
iii.
The “Doing Business As” (D/B/A) name must be provided as it is registered with the
Florida Division of Corporations, if the business uses a fictitious name to conduct
business.
iv.
Provide the Federal Employer Identification Number (FEID) for the business.
v.
Provide the Talent Agency license number.
vi.
Select the box that indicates the type of business ownership for the talent agency.
vii.
Provide business contact information. The operator’s information should be used for
contact name. Contact information is often used to quickly resolve questions with
applications by telephone call or email.
c. Section III- Operator Information
i.
Provide the name, Social Security number, telephone number and email address for the
operator of the talent agency.
d. Section IV- Ownership Information
i.
This section should only be completed to update new or remove old ownership.
ii.
List all persons with an ownership stake in the business that is greater than or equal to
10%. This includes partners, associates, and profit managers who hold a financial
interest in the talent agency. If owned by a corporation, provide the name and percent of
ownership for the corporation(s) having ownership. Per Section 559.79, Florida Statutes.
iii.
If the talent agency is operating as a corporation or limited liability corporation, provide
the name, title, Social Security number, and address for each officer, director, chief
executive officer, or other person who is able to directly or indirectly control the operation
of the talent agency.
iv.
The “removal of owner” section should only be completed if a Talent Agency has more
than one owner and desires to remove, rather than replace, a previous owner. If an
owner is being removed and replaced with a new owner, all sections of the application
should be completed.
e. Section V- Applicant Information
i.
All NEW owners and operators of the talent agency must complete sections V, VI,
and VII.
ii.
Fill out each section completely. A Social Security number is required in order to apply
for any individual license within the Department of Business and Professional Regulation.
iii.
In the Full Legal Name section provide your full legal name as it appears on your Social
Security card. Do not use any nicknames or initials. Please list any aliases or prior names
in the Prior Name information section.
iv.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
v.
Applicants are required to provide at least one physical address – i.e., not a P.O. Box. If
the mailing address is not also your physical address, please provide a physical address.
vi.
Applicant’s addresses are used only for Department purposes and will not be printed on
the license.
vii.
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.
viii.
Applicants must provide information on current or prior licenses held in Florida or any
other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
ix.
Applicants must provide information on any prior names or aliases used by applicant. If
the name on supporting documentation does not match the applicant’s legal name, the
alias used in the supporting documentation must be provided in this section. Failure to do
so will result in a deficient application.
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003
f.
Section VI (a), (b), and (c)- Background Questions
i.
Applicants must submit answers to each of the background questions.
ii.
Question 1:
(1)
If you answer “Yes” to this question, you must complete Section VI (b) of the
application and provide a copy of the arrest report, copies of the disposition or final
order(s), and documentation proving all sanctions have been served and satisfied.
You must supply this documentation for each occurrence. If you are unable to
supply this documentation, a certified statement from the Clerk of Court for the
relevant jurisdiction stating the status of records is required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
iii.
Question 2:
(1)
If you answer “Yes” to this question, you must complete Section VI (c) of the
application and provide a copy of the judgment or decree. You must also supply
documentation proving all sanctions have been served and satisfied, or if not, stating
the current status of any proceedings.
iv.
Question 3:
(1)
If you answer “Yes” to this question, you must complete Section VI (c) of the
application and supply copies of documentation explaining the denial or pending
action.
v.
Question 4:
(1)
If you answer “Yes” to this question, you must complete Section VI (c) of the
application and supply copies of the order(s) showing the disciplinary action taken
against the license, or documentation showing the status of the pending action.
g. Section VII- Affirmation by Written Declaration
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.
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003
State of Florida
Department of Business and Professional Regulation
Division of Professions: Talent Agencies
Application for Change of Owner or Operator
Form # DBPR TA-2
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
APPLICATION TYPE
 Change of Owner and
 Change of Owner
 Change of Operator
 Removal of Owner
Operator
[4901/3022]
[4901/3023]
[4901/9006]
[4901/3022/3023]
Section II- Business Information
BUSINESS INFORMATION
Business Name
Doing Business As (D/B/A) Name
Federal Employer ID Number
License Number
Business Type:(Select ONE only)  Sole Proprietor  Corporation or LLC  Partnership
 Other
CONTACT INFORMATION
Contact Name:
Primary Phone Number
Primary E-Mail Address
Section III – Operator Information
OPERATOR INFORMATION
Last Name
First
Middle
Suffix
Social Security Number*
Phone Number
E-Mail Address
Section IV – Ownership Information
BUSINESS OWNERSHIP
Please list all persons with ownership greater than or equal to 10%. This includes partners, associates, and
profit managers who hold a financial interest in the talent agency. If owned by a corporation, provide the
name and percent ownership for the corporation(s) having ownership.
Name
%
Ownership
1.
2.
3.
4.
5.
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003
Section IV – Ownership Information – Continued
CORPORATIONS OR LLCs ONLY
Please provide the following information for each Officer, Director, Chief Executive or other
person who is able to directly or indirectly control the operation of the talent agency.
1. Name
Title
Social Security Number*
Street Address
City
State
Zip Code (+4 optional)
2. Name
Title
Social Security Number*
Street Address
City
State
Zip Code (+4 optional)
3. Name
Title
Social Security Number*
Street Address
City
State
Zip Code (+4 optional)
4. Name
Title
Social Security Number*
Street Address
City
State
Zip Code (+4 optional)
5. Name
Title
Social Security Number*
Street Address
City
State
Zip Code (+4 optional)
Section IV – Ownership Information – Continued
REMOVAL OF OWNER
Please list all current owners who you wish to remove. PLEASE NOTE: This section is only applicable if a
Talent Agency has more than one owner and should only be completed if an owner is being removed and not
being replaced. If an owner is being removed and replaced with a new owner, all sections of this application
should be completed.
Name of owners being removed
%
Ownership
1.
2.
3.
4.
5.
List new ownership percentages
%
Ownership
1.
2.
3.
4.
5.
DBPR TA-2 Change of Owner/Operator
Eff. Date: December 2017
Incorporated by Rule: 61-19.003