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Get Form 6031 2012-2024

DBPR ABT-6031 Division of Alcoholic Beverages and Tobacco Request for Withdrawal of Application STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DBPR Form ABT-6031 Revised 12/2012 If you have any questions or need assistance in completing this application please contact the Division of Alcoholic Beverages Tobacco s AB T local district office. Please submit your completed application 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 T s web site at the link provided below http //www. myflorida*com/dbpr/abt/districtoffices/licensing*html SECTION 1 - APPLICATION INFORMATION I request the withdrawal of the following application License/Permit Number Full Name of Applicant This is the name in which the license/permit was applied for Business Name D/B/A Location Address Street and Number City County State If you received a temporary license/permit is the temporary attached to this application Zip Code Yes No SECTION 2 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED I the undersigned individual or if a registered legal entity for itself its officers and directors hereby swear or affirm that I am duly authorized to make the above request. I swear under oath or affirmation under penalty of perjury as provided in Sections 559. 791 562. 45 and 837. 06 Florida Statutes 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 print name s of person s making statement known to me OR who produced as identification* Notary Public Auth. Please submit your completed application 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 T s web site at the link provided below http //www. myflorida*com/dbpr/abt/districtoffices/licensing*html SECTION 1 - APPLICATION INFORMATION I request the withdrawal of the following application License/Permit Number Full Name of Applicant This is the name in which the license/permit was applied for Business Name D/B/A Location Address Street and Number City County State If you received a temporary license/permit is the temporary attached to this application Zip Code Yes No SECTION 2 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED I the undersigned individual or if a registered legal entity for itself its officers and directors hereby swear or affirm that I am duly authorized to make the above request. myflorida*com/dbpr/abt/districtoffices/licensing*html SECTION 1 - APPLICATION INFORMATION I request the withdrawal of the following application License/Permit Number Full Name of Applicant This is the name in which the license/permit was applied for Business Name D/B/A Location Address Street and Number City County State If you received a temporary license/permit is the temporary attached to this application Zip Code Yes No SECTION 2 - AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED I the undersigned individual or if a registered legal entity for itself its officers and directors hereby swear or affirm that I am duly authorized to make the above request. I swear under oath or affirmation under penalty of perjury as provided in Sections 559. 791 562. 45 and 837. .

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