ࡱ> ^`YZ[\]y vbjbj {{%Y,,,,,DD,D,D,,/D, J4FLFFFGKM  $j/,+SGG+S+S/,,FFFujujuj+ST ,F,F uj+S ujujJ\}F\]ZEB: μ^x μ}}\μ,٢NOujP%QNNN//Qi$NNN +S+S+S+SμNNNNNNNNN *:  DBPR ABT-6001 Division of Alcoholic Beverages and Tobacco Application for New Alcoholic Beverage License STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form ABT-6001 Revised 08/2013 If you have any questions or need assistance in completing this application, please contact the Division of Alcoholic Beverages & Tobaccos (AB&T) local district office. Please submit your completed application and required fee(s) to your local district office. This application may be submitted by mail, through appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be found on AB&Ts web site at the link provided below:  HYPERLINK "http://www.myfloridalicense.com/DBPR/alcoholic-beverages-and-tobacco/contact/" \l "1494352843986-421b0e77-77ee" Local ABT District Licensing Offices SECTION 1 - CHECK LICENSE CATEGORYLicense Series Requested  FORMDROPDOWN Type/Class Requested  FORMDROPDOWN Do you wish to purchase a Temporary License?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoChild License Requested  FORMDROPDOWN Number of Child Licenses Requested  FORMDROPDOWN  FORMCHECKBOX  Retail Alcoholic Beverages  FORMCHECKBOX  Beer/Wine/Liquor Wholesaler FORMCHECKBOX  Alcoholic Beverage Manufacturer  FORMCHECKBOX  Passenger Waiting Lounge FORMCHECKBOX  Retail Tobacco Products Dealer Permit (must check one or more of the below)  FORMCHECKBOX  Pipes  FORMCHECKBOX  Over the Counter  FORMCHECKBOX  Vending Machine SECTION 2 LICENSE INFORMATIONIf the applicant is a corporation or other legal entity, enter the name and the document number as registered with the Florida Department of State Division of Corporations on the line below.FEIN Number  FORMTEXT      Business Telephone Number  FORMTEXT      FORMTEXT      FORMTEXT     E-Mail Address (Optional)  FORMTEXT      Full Name of Applicant(s): (This is the name the license will be issued in)  FORMTEXT      Department of State Document #  FORMTEXT      Business Name (D/B/A)  FORMTEXT       FORMTEXT      Location Address (Street and Number)  FORMTEXT      City  FORMTEXT       . .  FORMTEXT      County  FORMTEXT      State  FORMTEXT FLZip Code  FORMTEXT      Mailing Address (Street or P.O. Box)  FORMTEXT      City  FORMTEXT      State  FORMTEXT   Zip Code  FORMTEXT      Contact Person - This section is optional, see application instructions for detailsContact Person  FORMTEXT      Telephone Number  FORMTEXT      FORMTEXT      FORMTEXT      ext.  FORMTEXT      E-Mail Address (Optional)  FORMTEXT      Mailing Address (Street or P.O. Box)  FORMTEXT      City  FORMTEXT      State  FORMTEXT   Zip Code  FORMTEXT       ABT District Office Received Date Stamp SECTION 3  RELATED PARTY PERSONAL INFORMATIONThis section must be completed for each person directly connected with the business, unless they are a current licensee.1.Business Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  2.Full Name of Individual  FORMTEXT      Social Security Number*  FORMTEXT      FORMTEXT     FORMTEXT     Home Telephone Number  FORMTEXT      FORMTEXT      FORMTEXT     Date of Birth  FORMTEXT     FORMTEXT     FORMTEXT     Race  FORMDROPDOWN Sex  FORMDROPDOWN Height  FORMTEXT     Weight  FORMTEXT     Eye Color  FORMTEXT      Hair Color  FORMTEXT      3.Are you a U.S. citizen?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If no, immigration card number or passport number:  FORMTEXT      4.Home Address (Street and Number)  FORMTEXT      City  FORMTEXT      State  FORMTEXT   Zip Code  FORMTEXT      5.Do you currently own or have an interest in any business selling alcoholic beverages, wholesale cigarette or tobacco products, or a bottle club?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide the information requested below. The location address should include the city and state.Business Name (D/B/A)  FORMTEXT      License Number  FORMTEXT      Location Address  FORMTEXT      6.Have you had any type of alcoholic beverage, or bottle club license, or cigarette, or tobacco permit refused, revoked or suspended anywhere in the past 15 years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide the information requested below. The location address should include the city and state.Business Name (D/B/A)  FORMTEXT      Date  FORMTEXT      Location Address  FORMTEXT      7.Have you been convicted of a felony within the past 15 years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide the information requested below and provide a Copy of the Arrest Disposition, as requested in the Application Requirements checklist.Date  FORMTEXT      Location  FORMTEXT      Type of Offense  FORMTEXT      8.Have you been convicted of an offense involving alcoholic beverages or tobacco products anywhere within the past 5 years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide the information requested below and provide a Copy of the Arrest Disposition, as requested in the Application Requirements checklist.Date  FORMTEXT      Location  FORMTEXT      Type of Offense  FORMTEXT       9.Have you been arrested or issued a notice to appear in any state of the United States or its territories within the past 15 years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, provide the information requested below and a Copy of the Arrest Disposition. Attach additional sheet if necessary.Date  FORMTEXT      Location  FORMTEXT      Type of Offense  FORMTEXT      10.Do you meet the standards of the moral character rule?  FORMCHECKBOX  Yes  FORMCHECKBOX  No11.Are you an officer or employee of the Division of Alcoholic Beverages and Tobacco; are you a sheriff or other state, county, or municipal officer, including reserve or auxiliary officers, certified by the state as such, with arrest powers, whose certification is current and active?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoNOTARIZATION STATEMENT I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and 837.06, Florida Statutes, that I have fully disclosed any and all parties financially and or contractually interested in this business and that the parties are disclosed in the Disclosure of Interested Parties of this application. I further swear or affirm that the foregoing information is true and correct. STATE OF_____________________ COUNTY OF___________________ _________________________________________________ APPLICANT SIGNATURE The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of_______________, 20_____, By _______________________________________who is ( ) personally (print name of person making statement) known to me OR ( ) who produced ___________________________________________as identification. _______________________________________________ Commission Expires: ___________________ Notary Public (ATTACH ADDITIONAL COPIES AS NECESSARY) *Social Security Number Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance, disclosure of social security numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598, and 559.79, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and are used for licensee identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), 104 Pub.L.193, Sec. 317. The State of Florida is authorized to collect the social security number of licensees pursuant to the Social Security Act, 42 U.S.C. 405(c)(2)(C)(I). This information is used to identify licensees for tax administration purposes. This information is used to identify licensees for tax administration purposes, and the division will redact the information from any public records request. SECTION 4 DESCRIPTION OF PREMISES TO BE LICENSED TO BE COMPLETED BY THE APPLICANTBusiness Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  1.Yes  FORMCHECKBOX No  FORMCHECKBOX Is the proposed premises movable or able to be moved? 2.Yes  FORMCHECKBOX No  FORMCHECKBOX Is there any access through the premises to any area over which you do not have dominion and control?3. Yes  FORMCHECKBOX No  FORMCHECKBOX Is the business located within a Specialty Center? If yes, check the applicable statute:  FORMCHECKBOX  561.20(2)(b)1, F.S. or  FORMCHECKBOX  561.20(2)(b)2, F.S.4.Yes  FORMCHECKBOX No  FORMCHECKBOX Are there any mobile vehicles used to sell or serve alcoholic beverages?5.Yes  FORMCHECKBOX No  FORMCHECKBOX Are there more than 3 separate rooms or enclosures with permanent bars or counters?Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which are contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar locations and any other specific areas which are part of the premises sought to be licensed. A multi-story building where the entire building is to be licensed must show the details of each floor. SECTION 5 APPLICATION APPROVALS Full Name of Applicant: (This is the name the license will be issued in)  REF Text173 \h \* MERGEFORMAT  Business Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  Street Address  REF Text7 \h  \* MERGEFORMAT  City  REF Text8 \h  \* MERGEFORMAT . . County  REF Text9 \h  \* MERGEFORMAT  State  REF Text10 \h  \* MERGEFORMAT FLZip Code  REF Text11 \h  \* MERGEFORMAT   ZONING TO BE COMPLETED BY THE ZONING AUTHORITY GOVERNING YOUR BUSINESS LOCATION The location complies with zoning requirements for the sale of alcoholic beverages or wholesale tobacco products pursuant to this application for a Series:  REF Dropdown1 \h \* MERGEFORMAT   Type:  REF Dropdown2 \h \* MERGEFORMAT   license. This approval includes outside areas which are contiguous to the premises which are to be part of the premises sought to be licensed and are identified on the sketch?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Check either: Please do not skip, this is important for license fee sharing  FORMCHECKBOX  Location is within the city limits or  FORMCHECKBOX  Location is in the unincorporated county Signed____________________________________________________Date__________________ Title_________________________________________ This approval is valid for days.  SALES TAX TO BE COMPLETED BY THE DEPARTMENT OF REVENUEThe named applicant for a license/permit has complied with the Florida Statutes concerning registration for Sales and Use Tax. This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns appear to have been paid through the period ending _______________ or the liability has been acknowledged and agreed to be paid by the applicant. This verification does not constitute a certificate as contained in Section 213.758 (4), F.S. (Not applicable if no transfer involved). Furthermore, the named applicant for an Alcoholic Beverage License has complied with Florida Statutes concerning registration for Sales and Use Tax, and has paid any applicable taxes due. Signed____________________________________________________Date_____________________ Title____________________________________________ Department of Revenue Stamp This approval is valid for days.  HEALTH TO BE COMPLETED BY THE DIVISION OF HOTELS AND RESTAURANTS OR COUNTY HEALTH AUTHORITY OR DEPARTMENT OF HEALTH OR DEPARTMENT OF AGRICULTURE & CONSUMER SERVICESThe above establishment complies with the requirements of the Florida Sanitary Code. Signed_______________________________________________________Date____________________ Title________________________________________________ Agency____________________________ This approval is valid for days. SECTION 6 APPLICANT ENTITY FELONY CONVICTION Business Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  Has the applicant entity been convicted of a felony in this state, any other state, or by the United States in the last 15 years?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If the answer is  Yes, please list all details including the date of conviction, the crime for which the entity was convicted, and the city, county, state and court where the conviction took place.   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      (Attach additional sheets if necessary) SECTION 7  SPECIAL LICENSE REQUIREMENTS (DOES NOT APPLY TO BEER AND WINE LICENSES)Please check the appropriate box of the license for which you are applying. Fill in the corresponding requirements for the license type sought.  FORMCHECKBOX  Quota Alcoholic Beverage License  FORMCHECKBOX  Specialty Alcoholic Beverage License (e.g. SRX, S, etc)  FORMCHECKBOX  Club Alcoholic Beverage License This license is issued pursuant to  FORMTEXT       , Florida Statutes or Special Act, and as such we acknowledge the following requirements must be met and maintained: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Please initial and date: Applicant s Initials____________________________________ Date______________________________ SECTION 8  DISCLOSURE OF INTERESTED PARTIESNote: Failure to disclose an interest, direct or indirect, could result in denial, suspension and/or revocation of your license. You MUST list all persons and entities in the entire ownership structure. To determine which of those persons must submit fingerprints and a Related Party Personal Information, sheet, see the fingerprint section in the application instructions. 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$IfgdaWkd$$Ifl4    0#'&80    +4 laf4p ytv`````````````````````aaaaa a"aֱyr\ֱFֱ+jhudbh $CJOJQJU^J+jhudbh4#CJOJQJU^J hudbh $+jhudbh4#CJOJQJU^JhudbhaWCJOJQJ^J%jhudbhaWCJOJQJU^Jhudbh $CJOJQJ^J*jh CJOJQJU^JmHnHu%jhudbh $CJOJQJU^J+j-hudbh $CJOJQJU^J`` aHalabYYM $$Ifa$gd4# $IfgdaWkd$$Ifl4    F #'80    +    4 laf4pytv"a6a8a:aDaFaHaJa^a`abahajaaabPRnȲȫȲȆsq[ssJJ hudbh $CJOJQJ^JaJ+jMhudbh $CJOJQJU^JU%jhudbh $CJOJQJU^Jhudbh $CJOJQJ^J+jhudbh4#CJOJQJU^J hudbh $*jh CJOJQJU^JmHnHu%jhudbhaWCJOJQJU^J+jhudbh4#CJOJQJU^JhudbhaWCJOJQJ^JlanaabYY $Ifgd4#kd$$Ifl4    F #'80    +    4 laf4pytv     OTHER INTERESTS These questions must be answered about this business for every person or entity listed as the applicant1. Are there any persons or entities not disclosed who have loaned money to the business? FORMCHECKBOX  Yes  FORMCHECKBOX  No2. Are there any persons or entities not disclosed that derive revenue from the license solely through a contractual relationship with the licensee, the substance of which is not related to the control of the sale of alcoholic beverages, or is exempt by statute or rule? FORMCHECKBOX  Yes  FORMCHECKBOX  No3. Are there any persons or entities not disclosed that have the right to receive revenue based on a contractual relationship related to the control of the sale of alcoholic beverages? FORMCHECKBOX  Yes  FORMCHECKBOX  No4. Are there any persons or entities not disclosed who have a right to a percentage payment from the proceeds of the business pursuant to the lease? FORMCHECKBOX  Yes  FORMCHECKBOX  No5. Are there any persons or entities not disclosed who have guaranteed the lease or loan? FORMCHECKBOX  Yes  FORMCHECKBOX  No6. Are there any persons or entities not disclosed who have co-signed the lease or loan? FORMCHECKBOX  Yes  FORMCHECKBOX  No7. Is there a management contract, franchise agreement, or concession agreement in connection with this business? FORMCHECKBOX  Yes  FORMCHECKBOX  No8. Have you or anyone listed on this application, accepted money, equipment or anything of value in connection with this business from any industry member as described in 61A-1.010, Florida Administrative Code? FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf you answered yes to any of the above questions, a copy of the agreement must be submitted with this application. The terms of the agreement may require the interested persons or parties related to an entity to submit fingerprints and a related party personal information sheet. SECTION 9 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIREDBusiness Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  I, the undersigned individually, or on behalf of a legal entity, hereby swear or affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear or affirm that the attached sketch is a true and correct representation of the entire area and premises to be licensed and agree that the place of business, if licensed, may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for the purposes of determining compliance with the beverage and retail tobacco laws. I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and 837.06, Florida Statutes, that the foregoing information is true and that no other person or entity except as indicated herein has an interest in the alcoholic beverage license and/or tobacco permit, and all of the above listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license and/or tobacco permit. STATE OF________________________ COUNTY OF______________________ _________________________________________________ APPLICANT/AUTHORIZED REPRESENTATIVE NAME _________________________________________________ APPLICANT/AUTHORIZED REPRESENTATIVE SIGNATURE The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this ___________Day of_______________, 20_____, By _______________________________________who is ( ) personally (print name(s) of person(s) making statement) known to me OR ( ) who produced ___________________________________________as identification. ________________________________________________ Commission Expires: ___________________ Notary Public SECTION 10 - CURRENT LICENSEE UPDATE DATA SHEETThis section is to be completed for all current alcoholic beverage and/or tobacco license holders listed on the application to ensure the most up to date information is captured.Business Name (D/B/A)  REF Text1 \h \* MERGEFORMAT  Last Name  FORMTEXT      First  FORMTEXT      M.I.  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FORMTEXT  Current Alcohol Beverage and/or Tobacco License Permit/Number(s)  FORMTEXT      Date of Birth  FORMTEXT     FORMTEXT     FORMTEXT     Social Security Number*  FORMTEXT      FORMTEXT     FORMTEXT     Street Address  FORMTEXT      City  FORMTEXT  pPrPPQull $Ifgd%kdV4$$Ifl    %F& 0    '    4 layt%PP Q QQQQQQ:QR@RBR`RbRvRxRzRRRRRRRRҺҩҩҺҩҩyҺҩjҩRҺҩjҩ/j<hudbh CJOJQJU^JaJhudbh CJOJQJ^J/j;hudbh CJOJQJU^JaJ/j:hudbh CJOJQJU^JaJ hudbh CJOJQJ^JaJ.jh CJOJQJU^JaJmHnHu)jhudbh CJOJQJU^JaJ/j9hudbh CJOJQJU^JaJ @RBR`RR $Ifgd%vkd^<$$Ifl    %0&h0    '4 layt%RRRRRRR$S $Ifgd%ckd=$$Ifl    %&'0    '4 layt%RRRRRRRRRRRRRRSSS S"S$S&S:Shudbh CJOJQJU^JaJ$S&S:SbSnSSSSullllll $Ifgd%kd@$$Ifl    %FP&0    '    4 layt%SSSSSSSSSSSSSSDTFTZT\T^ThTjTlTnTTTTTTTTTTTҺҩҩҺҩҩjҺҩҩRҺҩҩ/jUDUFUHUJU^U`UbUfUhUjUlUUҺҩҩҺҩҩyҺҩҩaҺҩҩ/jIhudbh CJOJQJU^JaJ/jIhudbh CJOJQJU^JaJ/jHhudbh CJOJQJU^JaJ hudbh CJOJQJ^JaJ.jh CJOJQJU^JaJmHnHu)jhudbh CJOJQJU^JaJ/j(Ghudbh CJOJQJU^JaJUUUUUUUUUUUUUUUUUUUUUVtt ttt.t0t2t6t8tҺҩҩҺҩҩjҺhҩҩPҺ/jLNhudbh 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=!"#Z$v%  Dpg$$If!vh#vz#v#v@ :V l',5z55@ 4yt&aDyK  yK http://www.myfloridalicense.com/DBPR/alcoholic-beverages-and-tobacco/contact/yX;H,]ą'c1494352843986-421b0e77-77ee$$If!vh#v':V l4,  6` 0',5'/ /  / /  4f4p yt4Df Dropdown1?Use the drop-down to select the license series, and press {Tab} 1APS2APS1COP2COP3PS3APS3BPS3CPS3DPS4COP5COP6COP7COP8COP11PA11C11CS11AL11CT11CG12RTDf Dropdown2PUse the drop-down to select the type of license (if applicable), and press {Tab} DSPCSHSRXSBXSPXSALSCXSCCSASAXHBXDeCheck2AClick or use {Space Bar} to select/deselect "Yes" and press {Tab}DeCheck3@Click or use {Space Bar} to select/deselect "No" and press {Tab}$$$If!vh#vD #v~ #vV:V l43 6`0',,5D 5~ 5V/  / / / /  4f4pyt8Df 3M3M (up to 5 bars)3M (6-10 bars)3M (more than 10 bars)CMBPGC11CXDf Dropdown6  1234567891011+0$$If!vh#vD #v#v:V l43 6`0',5D 55/  /  / / / / /  4f4pytqDeCheck4>Click or press {Space Bar} to select/deselect, and press {Tab}DeCheck5>Click or press {Space Bar} to select/deselect, and press {Tab}DeCheck6>Click or press {Space Bar} to select/deselect, and press {Tab}DeCheck8>Click or press {Space Bar} to select/deselect, and press {Tab}$$If!vh#v #v^:V l> 6`0',5 5^/  / / / /  4ytqDeCheck7>Click or press {Space Bar} to select/deselect, and press {Tab}vDeCheck54vDeCheck55vDeCheck56$$If!vh#v':V l% 6`0',5'/ /  /   4ytq$$If!vh#v':V l  0    '5'/  / 4ap yttV$$If!vh#v':V l40    '5'/ 4af4yttVDA(AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}xD2Text175$$If!vh#v #v@ #v:V l40    '5 5@ 5/ 4af4ytZxD2Text173DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v^#v :V l40    ',5^5 / 4af4ytZtDFText1DAUAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v':V l40    '5'/ 4af4ytZDAFText7;Enter the location address of the business, 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&+55o5k/ / 4f4yt1'xDAText178$$If!vh#v#v$:V l430    &+55$4f4yt1'DeCheck19GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck20FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#v#v$:V l430    &55$4f4p ytioDeCheck19GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck20FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#v#v$:V l40    &55$4f4p ytsI$$If!vh#v&:V l4   0    &5&4f4p yt gf$$If!vh#v&:V l40    &5&4f4yt/$$If!vh#v&:V l4%  0    &5&4af4p yt9mDyK Text1$$If!vh#v&:V l4%0    &5&/ 4af4yt9DeCheck21GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck22FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#vp#v#v#v.:V l0    &,5p555.4aytDeCheck23GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck24FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#vp#v#v#v.:V l0    &,5p555.4ap(ytDeCheck21GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck22FClick or use the {Space bar} to select / deselect "No" and press {Tab}vDeCheck57vDeCheck58$$If!vh#vp#v#v#v.:V l0    &,5p555.4ap(ytDeCheck21GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck22FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#vp#v#v#v.:V l0    &,5p555.4ap(ytDeCheck21GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck22FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#vp#v#v#v.:V l440    &,5p555./ 4af4yt$$If!vh#v&:V l4F0    &5&4af4yt$$If!vh#v&:V l4(0    &5&4af4ytQ$$If!vh#v':V l4%  0    '5'4` af4p yttVqDyK Text173$$If!vh#v':V l0    '5'4ayttVmDyK Text1$$If!vh#v':V l0    '5'4ayttVmDyK Text7$$If!vh#v':V l0    '5'4ayttVmDyK Text8mDyK Text9oDyK Text10oDyK Text11$$If!vh#v#v@ #v*#v:V l30    '55@ 5*54ayt7hj$$If!vh#v':V l  0    '5'/  / 4ap yttVuDyK  Dropdown1uDyK  Dropdown2DeCheck25GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck26FClick or use the {Space bar} to select / deselect "No" and press {Tab}DAClick or use {Space Bar} to select/deselect "Yes" and press {Tab}DeAClick or use {Space Bar} to select/deselect "Yes" and press {Tab}$$If!vh#v':V l0    '5'4ayt]r$$If!vh#v':V l  0   '5'/  4ap yttV$$If!vh#v':V l40   '5'/ / /  4af4yttV$$If!vh#v':V l4%0   '5'/ /   4af4yt: j$$If!vh#v':V lG  0   '5'/  4p yttV$$If!vh#v':V l40   '5'/   4f4yt: j$$If!vh#vd&:V lq  0    d&5d&/  / 4p ytmDyK Text1$$If!vh#vd&:V l30    d&5d&/ 4p ytDeCheck35GClick or use the {Space bar} to select / deselect "Yes" and press {Tab}DeCheck36FClick or use the {Space bar} to select / deselect "No" and press {Tab}$$If!vh#vd&:V l40    d&5d&4f4p ytDFText67Enter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p ytDFEnter details, and press {Tab}$$If!vh#vd&:V l4%0    d&5d&4f4p yt$$If!vh#vd&:V l4%0    d&5d&4f4p yt$$If!vh#v&:V l  0   &5&/  4p yt Q,DeCheck37[Click or use the {Space bar} to select / deselect this special license type and press {Tab},DeCheck38[Click or use the {Space bar} to select / deselect this special license type and press {Tab},DeCheck39[Click or use the {Space bar} to select / deselect this special license type and press {Tab}$$If!vh#v&:V l4A0   &5&/ / /  4f4yt QxDText180$$If!vh#v&:V l40   &5&/ /  4f4yt QDKText161@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ / /  4f4yt5JDKText162@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ /  4f4yt2DK@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ /  4f4yt2DK@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ /  4f4yt2DKText162@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ /  4f4yt2DKText162@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ /  4f4yt2DKText162@Enter the special requirements for this license, and press {Tab}$$If!vh#v&:V l4%0   &,5&/ / /  4f4yt2$$If!vh#v&:V l4X0   &,5&/ /   4f4yt$$If!vh#v+:V l4  0    +5+4af4p ytaW$$If!vh#v+:V l4L0    +5+4af4ytaWmDyK Text1$$If!vh#v+:V l4L0    +5+4af4ytaW$$If!vh#v+:V l4L0    +5+4af4ytaW$$If!vh#v#v#v8:V l4L0    +,55584af4ytv$$If!vh#v+:V l40    +,5+4af4p ytaWDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytv$$If!vh#v+:V l40    +,5+4af4p ytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pyt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}xDText198$$If!vh#v#v#v8:V l40    +,55584af4pyt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pyt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p yt9$$If!vh#v&#v8:V l40    +,5&584af4p yt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p yt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p yt9DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p yt9$$If!vh#v+:V l40    +,5+4af4ytaWDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p ytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4p ytv$$If!vh#v&#v8:V l40    +,5&584af4p ytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytvDAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DA<AEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v#v#v8:V l40    +,55584af4pytvDAKAEnter the Trade Name or "Doing Business As" Name, and press {Tab}$$If!vh#v+:V l40    +,5+4af4p ytaW$$If!vh#v+:V l430    +,5+4af4p ytaWvDeCheck54vDeCheck55$$If!vh#v"#vp:V l430    +,5"5p4af4pytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l4M0    +,5"5p4af4pytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l4M0    +,5"5p4af4pytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l430    +,5"5p4af4pytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l430    +,5"5p4af4pytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l430    +,5"5p4af4ytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l430    +,5"5p4af4ytudbvDeCheck54vDeCheck55$$If!vh#v"#vp:V l4M0    +,5"5p4af4ytudb$$If!vh#v+:V l4M0    +5+4af4ytaW$$If^!vh#v`':V l4  0   `'5`'/  4a^f4p ytp9mDyK Text1$$If^!vh#v`':V l4 0   `'5`'4a^f4yt$$If^!vh#v`':V l4,$0   `'5`'4a^f4ytC$$If!vh#v':V l%  0    '5'4p yt%$$If!vh#v':V l%0    '5'/ 4yt%mDyK Text1$$If!vh#v':V l%0    '5'/ 4yt%DText112 Enter last name, and press {Tab}DText116!Enter first name, and press {Tab}D Enter last name, and press {Tab}$$If!vh#v#v #v:V l%0    ',55 5/  / / / / 4yt%8DUgEnter the beverage and tobacco license numbers for this applicant, separated by commas, and press {Tab}$$If!vh#v':V l%0    ',5'/ 4yt%DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DText1309Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}$$If!vh#v:V l%0    ',54yt%D-Text1435Enter the applicant's street address, and press {Tab}$$If!vh#v':V l%0    ',5'4yt%D(Text147+Enter the applicant's city, and press {Tab}DText151 Uppercase;Enter the two-character state abbreviation, and press {Tab}D Text155/Enter the applicant's zip code, and press {Tab}$$If!vh#v#v#v:V l%0    ',555/ 4yt%DText112 Enter last name, and press {Tab}DText116!Enter first name, and press {Tab}D Enter last name, and press {Tab}$$If!vh#v#v #v:V l%0    ',55 5/  / / / / 4yt%FDUText124gEnter the beverage and tobacco license numbers for this applicant, separated by commas, and press {Tab}$$If!vh#v':V l%0    ',5'/ 4yt%DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DText1309Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}$$If!vh#v:V l%0    ',54yt%DU5Enter the applicant's street address, and press {Tab}$$If!vh#v':V l%0    ',5'4yt%D(+Enter the applicant's city, and press {Tab}DText151 Uppercase;Enter the two-character state abbreviation, and press {Tab}D Text155/Enter the applicant's zip code, and press {Tab}$$If!vh#v#v#v:V l%0    ',555/ 4yt%DText112 Enter last name, and press {Tab}DText116!Enter first name, and press {Tab}D Enter last name, and press {Tab}$$If!vh#v#v #v:V l%0    ',55 5/  / / / / 4yt%8DUgEnter the beverage and tobacco license numbers for this applicant, separated by commas, and press {Tab}$$If!vh#v':V l%0    ',5'4yt%DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press 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Business As" Name, and press {Tab}DText1309Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}D9Enter applicant's social security number, and press {Tab}$$If!vh#vh#v:V l%0    ',5h54yt%DU5Enter the applicant's street address, and press {Tab}$$If!vh#v':V l%0    ',5'4yt%D(+Enter the applicant's city, and press {Tab}D UPPERCASE;Enter the two-character state abbreviation, and press {Tab}D Text155/Enter the applicant's zip code, and press {Tab}$$If!vh#v#v#v:V l%0    ',555/ 4yt%DText112 Enter last name, and press {Tab}DText116!Enter first name, and press {Tab}D Enter last name, and press {Tab}$$If!vh#v#v #v:V l%0    ',55 5/  / / / / 4yt%8DUgEnter the beverage and tobacco license numbers for this applicant, separated by commas, and press {Tab}$$If!vh#v':V l%0    ',5'4yt%DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or "Doing Business As" Name, and press {Tab}DAAEnter the Trade Name or 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