Form Dbpr Abt-6002 - Examination Application For Multiple License Locations Page 2
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13SECTION 3 – LICENSE INFORMATION
Note: You must attach a list of all the locations sought to be licensed by this application. This information
must include the business name and the complete location address. Applicable sections of the “Current
Licensee Update Data Sheet” must be completed for each location.
Full Name of Applicant
(If this is a corporation or other legal entity, enter the name as registered with the Secretary of State)
Trade Name (D/B/A)
FEIN Number
Business Telephone Number
Mailing Address (Street and Number)
City
County
State
Zip Code
Resident Agent/ Contact Person
Telephone Number
Street Address
City
County
State
Zip Code
Original application filed in (district office):
List all locations sought to be licensed by this application (Attach additional sheets if necessary):
Trade Name (D/B/A)
Street Address
City
County
State
Zip Code
Trade Name (D/B/A)
Street Address
City
County
State
Zip Code
Trade Name (D/B/A)
Street Address
City
County
State
Zip Code
Trade Name (D/B/A)
Street Address
City
County
State
Zip Code
Trade Name (D/B/A)
Street Address
City
County
State
Zip Code
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Parent category: Legal