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Get Fl Dacs-13605 2014

ON ADAM H. PUTNAM COMMISSIONER Check or Money Order Payable to FDACS: Bureau of Licensing and Enforcement Revenue Processing Section P.O. Box 6710 Tallahassee, FL 32399-0800 Section 482.071, F.S. and Rule 5E-14.142, F.A.C. Telephone: (850) 617-7997 DO NOT FILL IN License Year: License No. Date Issued: Business Closed Out-of-Business ( ) Merger ( ) Merger With: Effective Date: PLEASE FILL IN THE FOLLOWING INFORMATION COMPLETELY AND LEGIBLY: 1. Application is hereby made for the following .

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