HomeMy WebLinkAboutLiquor License -- DBPR AST-6001—Division of Alcoholic Beverages and Tobacco
Application for New Alcoholic Beverage License
STATE OF FLORIDA DBPR Foran
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6001
Revised 08/2013
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
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&T's web site at the link provided below.,
http://www.mvflorida.com/dbor/abt/distriat officesAicensino.html
Y C
License Series Requested Type/Class Requested Do you wish to purchase a Temporary License?
DD Yes No
Child License Requested Number of Child Licenses Requested
❑ Retail Alcoholic Beverages ❑x Alcoholic Beverage Manufacturer
❑ Beer/Wine/Liquor Wholesaler El Passenger Waiting Lounge
El.Retail Tobacco Products Dealer Permit(must check one or more of the below)
ElPipes El Over the Counter ❑VendingMachine
If 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 Business Telephone Number E-Mail Address(Optional)
82-1366861 1954-605-4452
Full Name of Applicant(s):(This is the name the license will be issued in) Department of State Document#
ISLANORADA DISTILLING LLC L17000046385
Business Name(D/B/A)
ISLAMORADA DISTILLING LLC
Location Address(Street and Number)
3250 SAINT LUCIE BLVD. , UNIT A
City County State Zip Code
FORT PIERCE ST.LUCIE FL 34936
Mailing Address(Street or P.O.Box)
3250 SAINT LUCIE BLVD., UNIT A
City State Zip Code
FORT PIERCE FL 34936
':Conti ctpefson: Thl's-secNo�rrls= onal`sae"a: 11606hlristhictionsfor'deiails
Contact Person I Telephone Number
SAMUEL RUBERT 305 791 4199 ext.
E-Mail Address(Optional)
srubert@rubertlaw.com _
Mailing Address(Street or P.O.Box)
3250 SAINT LUCIE BLVD. , UNIT A
City State Zip Code
FORT PIERCE FL 34936
ABT District Office Received Date Stamp
Auth.61A-5.010&61A-5.056,FAC 1
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i+ulf.hlame_of pppUpant (.-Thj&is the<,name iiia)Icense wftl Uel:rasu8+�tri}
iszAt�oiA nzsm�aaL�z�G, LSD
8.usttiossName(DIBTA)'_
t-SLANloRA A:DT'STIyLINc:ZLc,
Street Address,
IiUG�1 .]3I VIx..,. UNIT A
Gi .-Odunty State dip C9de'
STS T4UGIE:.. ;Ffr_
3494F,.
A. The location camplies%d -.zoning xOquiretne*,-for tt i sate"of:alcohQlio 6eversges pr,Whoie$ale.7
topacco prgiiuets p rsuarit to tMis.0.11catior4 for a Senes:. .DD Type:, fieerise:
t3, Thio approvar includes outside areas wh�oh::are coat guou.,s t the PireiniseS..,p�Vn:,-a' :.to bepsYt of trleprertttseS: ought f o be ilcertsed anii:are rd iltfied,dn the-skefch ' D` Yes.
Check eltfter: P. e'd. :not 010;thoi-U i doafor..ltIM1 fee sharing
D Lvcatlon i.w w ji*MPWor. LodaU n is; .1ho 1ffinporporoted.courtty,
. _.Date �� &._/!1
Signed ,.....
. fide -2r dc' This approval�s_vaild r days..
� . ..
The narhed..applicari#fora ticenselperrnit tics complied with'the Fiodda Stafutes concerning regrstratioriior
Sales and.Use Talc:
tl his 18 tit veOfy thatthe current`Dwner as naMed; this appiicaticrn ttas`fi(ed`alt'returns_arid'thatall
:outstanding billings and returns apptearfa have.beett pa,d through the pen, ending
or'tha liability Masesn acki�owiedged aid:agrees#to
j$6 gid ray the appieont This verifcat[bn does not
constitute a ce t ficate as conteiri d In.Seottott 214,'69'(4),F S ,(�toi,applicab[e if rTa transfer i nrotvedk:
2Furthermore,the>namei apps(cant for an Alcaholrc Beverage facense Etas.corriplted vaifh.Fiarlda:;5taftttes-
cOocemmg rogistrafion`for ales end.tJse Taxi artd,tias.paid ahy appllcatile#axes: ue
Signed°
Ttte [7epertrr►ent of Revenue 86M
Thsy app ova#fs veitdfor ziays .
'fhe abotio estatilishmant complres V0h they requir6mefIjsW the:Floeida-Seraitary Codd
Tifie> __ Agency
°Thisapprpvai'is valid for ;days,
Qpth,fill;4.'DlD:&:67A-5:056;:FAG 5.;
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