Form ABT-6033 Quota License Drawing Entry Form - Florida

Form abt-6033 or the "Quota License Drawing Entry Form" is a form issued by the Florida Department of Business & Professional Regulation.

Download a fillable PDF version of the Form abt-6033 down below or find it on the Florida Department of Business & Professional Regulation Forms website.

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DBPR ABT-6033 – Division of Alcoholic Beverages and Tobacco
Quota License Drawing Entry Form
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-1021
For Division Use Only
A. ENTRY FORM FOR
COUNTY
B. LIST ALL INTERESTED PERSONS
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Attach additional page if necessary)
C. Corporation or Other
Legal Entity:
(List officers, stockholders, etc.,
(Name of Entity)
in Section B above)
D. Mailing Address:
(Include City, State, and Zip Code)
AFFIRMATION
"I affirm under penalty of perjury that the information on this entry form is true to the best of my knowledge, and that no
other person, persons, firm, corporation, or other legal entity except as listed above, will have an interest in any alcoholic
beverage license obtained as a result of this drawing. I also affirm that to the best of my knowledge, none of the above
named persons or entities have made any other entry into the drawing for the county indicated above."
Print or Type Name
Signature
Print or Type Name
Signature
Print or Type Name
Signature
(Attach additional page for signatures, if necessary)
abt-6033 Quota License Drawing Entry From.doc Effective 09/2008
DBPR ABT-6033 – Division of Alcoholic Beverages and Tobacco
Quota License Drawing Entry Form
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
1940 North Monroe Street
Tallahassee, FL 32399-1021
For Division Use Only
A. ENTRY FORM FOR
COUNTY
B. LIST ALL INTERESTED PERSONS
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Last Name)
(First Name)
(Middle Name)
(Date of Birth)
(Attach additional page if necessary)
C. Corporation or Other
Legal Entity:
(List officers, stockholders, etc.,
(Name of Entity)
in Section B above)
D. Mailing Address:
(Include City, State, and Zip Code)
AFFIRMATION
"I affirm under penalty of perjury that the information on this entry form is true to the best of my knowledge, and that no
other person, persons, firm, corporation, or other legal entity except as listed above, will have an interest in any alcoholic
beverage license obtained as a result of this drawing. I also affirm that to the best of my knowledge, none of the above
named persons or entities have made any other entry into the drawing for the county indicated above."
Print or Type Name
Signature
Print or Type Name
Signature
Print or Type Name
Signature
(Attach additional page for signatures, if necessary)
abt-6033 Quota License Drawing Entry From.doc Effective 09/2008
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
1940 NORTH MONROE STREET. TALLAHASSEE, FLORIDA 32399-1021
QUOTA LICENSE DRAWING ENTRY FORM
GENERAL INSTRUCTIONS
You may wish to read 561.19, F.S., which regulates the issuance of new quota licenses.
This entry form must be typed or neatly printed in ink and all questions answered. Only properly completed entry forms will be accepted
and included in the drawing. If you win the right to apply for a quota license, please note this is part one (1) of a two (2)-part process.
The division will accept entry forms and award licenses (part 2) only to those persons listed on this entry form, provided those persons
are qualified under the beverage laws.
Only one entry form per county from person(s) directly or indirectly (financially) interested in the license or licensed business is
authorized for inclusion in the drawing for each county. (For example: submitting two entry forms for the same county, one as an
individual and another as part of a corporation, will result in one of the entry forms being denied.) The $100 filing fee will not be
refunded for any reason. Please be sure that you thoroughly read and understand the AFFIRMATION section before you sign this
entry form. Persons filing a false entry form or information may be prosecuted and their entry form denied.
A separate entry form must be filed for each county. A NON-REFUNDABLE filing fee of $100 is required and must accompany each
entry form. If you are submitting more than one entry form at the same time, you may include all of your fees in one payment.
The division will accept entry forms for 45 days beginning the third Monday in August. The division must receive all entry forms before
the deadline noted on the division’s website. No exceptions. Mail the completed entry form, including payment (check or money order
made payable to the division), to: DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO, Attention: Quota License Drawing,
1940 North Monroe Street, Tallahassee, Florida 32399-1021.
If your entry form is incomplete, you will receive a deficiency letter and will have fourteen (14) days from the date we mail the deficiency
letter to correct your entry form. The division must receive your corrected entry form prior to the fourteen (14) day deadline or your entry
form will be denied.
ENTRY FORM INSTRUCTIONS
A.
Enter the name of the county for which this entry form is being submitted. You may only list one county per entry form.
B.
The name of each individual entrant, corporate officer, directly interested person, etc. is required to be entered in Part B. A
person “Interested” in the license or licensed business includes, but is not limited to, a person who agrees to do any of the
following: enter into any financial arrangement through joint funds, investing funds, cosigning or guaranteeing a note or lease, or
any action that creates funds for a transaction or the ability of the business to operate. This may include Spouse, Officer(s),
Director(s), Stockholder(s), Chief Executive, Limited and General Partner(s), Corporation(s), or any other entity connected with
the business. The date of birth must be included for all persons listed on the entry form.
C. If the applicant is a corporation or other legal entity, complete Part C.
D. The division will mail all correspondence to the address listed in Part D. It is your responsibility to ensure the division has your
current mailing address at all times by notifying the division by phone, e-mail, or in writing via fax or at the mailing address
above.
You may attach additional pages if necessary. If you attach additional pages, you should indicate that you have done so in the
corresponding section of the entry form.
SIGNATURES
The entry form must include the original signature of each person listed in Part B. If you are signing for another person, a
notarized Power-of-Attorney giving you that authority must be included with this entry form. If you filled out Part C, only the
signature of an authorized individual(s) is required.
Note: We encourage you to file your entry forms as early in the 45-day period as possible. This will give
us the ability to review them and address deficiencies more quickly. We believe this will also decrease
the time between the end of the 45-day period and when the drawing will occur.
abt-6033.doc Effective 09/2008
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