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FLORIDA DEPARTMENT OF AGRICULTURE _ CONSUMER SERVICES

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					FLORIDA DEPARTMENT OF AGRICULTURE &
         CONSUMER SERVICES

       Division of Consumer Services




        CHARLES H. BRONSON
          COMMISIONER
              PAWNBROKING

         REGISTRATION PACKAGE

            Chapter 539.001, Florida Statutes
    FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES

              FLORIDA PAWNBROKING REGISTRATION PACKET

                            TABLE OF CONTENTS

          1. Tables of Contents…………………………………………. page I

          2. Filing Instructions………………………………………….                 page II

          3. Initial Registration Checklist………………………………. page III

          4. Registration Application…………………………………...             page 1-3

          5. Sample Certificate of Deposit Assignment Form………….   page 4

          6. Net Worth Affidavit……………………………..................     page 5-6




DACS – 10111 Rev. 1/08
I
         FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES

                                          FILING INSTRUCTIONS

                                    FLORIDA PAWNBROKING ACT
                                    CHAPTER 539.001, Florida Statutes

Effective October 1, 1996, Chapter 539, Florida Statutes, The Florida Pawnbroking Act, requires any person
operating as a pawnbroker to annually obtain a license from the Department of Agriculture and Consumer Services.
Pawnshops are also required to use a pawnbroker transaction form that contains specific information as required by
Chapter 539, Florida Statutes.

It is a violation of the Florida Pawnbroking Act for any person to engage in the business of making pawns without
first obtaining a license from the Department. Failure to comply with this law will subject violators to injunctive and
other relief, including fines of up to $5,000 per violation. In addition, you must show proof of licensure from the
Department prior to obtaining or renewing your local occupational license.

Enclosed are the forms to file with the Department, along with a copy of the law. Also enclosed are sample copies of
the pawnbroker transaction forms which have been approved by the Department. The actual form used by your
business must be submitted to the Department for review and approval prior to use.

The annual license fee is $300 per location. In addition, there is a $45.25 background investigation fee for each
Principal in the business. Principals are: every owner or beneficial owner of at least 10% of the business, partner,
officer, or director. Please return to the Department: (1) the application; (2) $300 filing fee plus $45.25 background
investigation fee and a set of fingerprints for each Principal; (3) proof of a net worth of at least $50,000, or an
original surety bond, letter of credit or certificate of deposit in the amount of $10,000 for each license; and (4) the
actual pawnbroker transaction form to be approved by the department.

If you have any questions, please contact the Division of Consumer Services at 1-800-HELP-FLA, or (850) 410-3715
or via facsimile at (850) 410-3804, or the pawn detail of your local law enforcement agency.




DACS – 10111 Rev. 1/08
II
         FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES

                                 INITIAL APPLICATION CHECKLIST

                                      FLORIDA PAWNBROKING ACT
                                      CHAPTER 539.001, Florida Statutes


IN ORDER TO PROCESS YOUR APPLICATION AS QUICKLY AS POSSIBLE, AND AVOID COSTLY
DELAYS, PLEASE VERIFY THAT ALL ITEMS LISTED HERE ARE INCLUDED PRIOR TO SENDING:

 _____ 1. Complete and notarize the application (including Federal Employer ID# and Sales Tax ID#)

 _____ 2. $300 fee for each location.

 _____ 3. Fingerprint card and a $45.25 fee for each operator and manager; each individual with at least 10 percent
          ownership; and all officers and directors if a corporation.

 _____ 4. Original Copy of the pawnbroker transaction form.

 _____ 5. Security Requirement; choose any one of A, B, C, or D. If ownership is corporation, all documents
          must be titled in the name of the corporation.

                A. Any applicant claiming to have a net worth of $50,000 or more shall file with the department,
                   at the time of applying for a license, the following documentation:

                    •    A current financial statement prepared by a Florida certified public accountant; OR

                    •    An affidavit stating the applicant’s net worth is at least $50,000 (see page 8 and 9),
                         accompanied by supporting documentation; OR

                    • If the applicant is a corporation, a copy of the applicant’s most recently filed federal tax
                      return.
                B. Submit $10,000 original Surety Bond (see sample form/language on pages 4 and 5 of 9.) One
                   bond for each location.

                C. Submit $10,000 original Irrevocable Letter of Credit (see sample form/language on page 7 of
                   9.) One Irrevocable Letter of Credit for each location.


                D. Submit $10,000 original Certificate of Deposit and Assignment Form (see sample form/
                   language on page 6 of 9.) One Certificate of Deposit and Assignment Form for each location.




DACS – 10111 Rev. 1/08
III
                                 FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES            Make check payable and remit application to:
                                                                                                 Florida Department of Agriculture and
                                                                                                 Florida Department
                                                                                                 Consumer Services of Agriculture                &
                                      REGISTRATION APPLICATION                                   Consumer Services
                                                                                                 P.O. Box 6700
                                             FLORIDA PAWNBROKING ACT                             Post Office Box 677
                                                                                                 Tallahassee, FL 32399-6700
                                                 Section 539.001, Florida Statutes                Tallahassee, FL 32314-6700
                                                                                                 www.800helpfla.com
 CHARLES H. BRONSON                                                                              1-800-HELP-FLA (435-7352) FL Only
                                                                                                 www.800helpfla.com 1-800-HELP-FLA
 COMMISSIONER                                                                                    Fax. (850) 410-3804  (FL Only FL
                                                                                                 1-850-488-2221 Calling outside – 435-7352)
                                                                                                 Fax 1-850-410-3804
      Note: All documents and attachments submitted with this Application are subject to public review pursuant to Chapter 119, F.S.
 1.       Annual Registration Fee: $300, for each Pawnshop plus the applicable fee, as indicated in the Filing Instructions (page II).
          Please submit a check or money order payable to the Department of Agriculture and Consumer Services. Note: All fees
          are non-refundable. This application will be returned if it does not bear an authorized signature or is incomplete.
                                                   BUSINESS INFORMATION
 2.       Check One:          New Filing               Renewal PN# _______                            Change of Owner

 3.       Legal Name of Business:

          DBA or Fictitious Name:

          Business Street Address:

          City, County, State, Zip:

          Mailing Address: (if different)

          City, County, State, Zip:

          Telephone Number:

          Fax Number (optional):

          E-mail Address (optional):

          Web Site (optional):

 4.       State of Florida Sales Tax ID:

          Federal Employer ID Number:
          (List Owner’s FEIN #, s.119.092)



 5.       Name of Contact Person:
                                                                                     (Authorized to receive Departmental Notices)
          Title of Contact Person

          Mailing Address:

          City, County, State, Zip:




                                                                                                         Org Code: 42100610000 A2
                                                                                                         Object Code: 001230 ($300.00) &
                                                                                                         004156 ($45.25 per person)




DACS – 10111 Rev. 1/08
Page 1 of 6
Florida Department of Agriculture and Consumer Services
Pawnbroking Registration Application

6.                                                     OWNERSHIP (Check One)

     Corporation: _________________________________________________________________________________________________
                                                Corporation name as registered with the Department of State

     Sole Proprietor:        ______________________________________________,                       _______________________________,     ________
                                                      Last Name                                                    First Name              MI.
     Partnership:            ______________________________________________,                       _______________________________,     ________
                                                      Last Name                                                    First Name              MI.
     Other:                  __________________________________________________________________________________________________________________
                                                                                      Please Describe

      Owner’s Street Address:         _______________________________________________________________________________________________________


         City, County, State, Zip:    _______________________________________________________________________________________________________


     Owner’s Mailing Address:         _______________________________________________________________________________________________________


         City, County, State, Zip:    _______________________________________________________________________________________________________


              Telephone Number:       _______________________________________________________________________________________________________


7.                            INFORMATION ABOUT OWNERS, PARTNERS OR OFFICERS
Please list the name and address of each direct or beneficial owner of at least 10%; the person in charge of daily operations and if
corporation, all corporate officers, partners, directors, and registered agents. Please indicate whether any of the individuals listed below
have been convicted of, entered a plea of guilty or nolo contendere to, had adjudication withheld for, or been incarcerated for a crime
within the last 10 years. Please indicate if any of the individuals listed below acting as a beneficial owner for someone who has been
convicted of, entered a plea of guilty or nolo contendere to, had adjudication withheld or been incarcerated for crime within the last 10
years?
Mark YES or NO. If yes, provide on a separate sheet, the name of such person, the nature of the offense, the court having jurisdiction, the
disposition of the offense, and the date of disposition.

Name:                  ____________________________________               Name:                         ____________________________________

Title:                 ____________________________________               Title:                        ____________________________________

Address:               ____________________________________               Address:                      ____________________________________

City, State, Zip:      ____________________________________               City, State, Zip:             ____________________________________

Phone #:               ____________________________________               Phone #:                      ____________________________________

Ownership %            ____________________________________               Ownership %                   ____________________________________
                                                   Yes / No                                                                            Yes / No
Name:                  ____________________________________               Name:                         ____________________________________

Title:                 ____________________________________               Title:                        ____________________________________

Address:               ____________________________________               Address:                      ____________________________________

City, State, Zip:      ____________________________________               City, State, Zip:             ____________________________________

Phone #:               ____________________________________               Phone #:                      ____________________________________

Ownership %            ____________________________________               Ownership %                   ____________________________________
                                                   Yes / No                                                                            Yes / No



DACS – 10111 Rev. 1/08
Page 2 of 6
Florida Department of Agriculture and Consumer Services
Pawnbroking Registration Application

                             LAW ENFORCEMENT INFORMATION
8.   What Law Enforcement Agency collects your pawnbroker transaction forms?

        a) Police Department: _________________________________________________________

              Contact Person:        _____________________________________________________________

              Telephone Number: _____________________________________________________________

        b) Sheriff’s Office          _____________________________________________________________

              Contact Person:        _____________________________________________________________

              Telephone Number: _____________________________________________________________


                                       TYPE OF SECURITY PROVIDED

9.             Check One:        Surety Bond (original enclosed or on file with the Department)
                                 Irrevocable Letter of Credit (original enclosed or on file with the Department)
                                 Certificate of Deposit (original enclosed or on file with the Department)
                                  Net worth of at least $50,000, no security required (please enclose a copy of a
                                  current financial statement prepared and verified by a Certified Public Accountant
                                  or the owner’s most recent filed federal income tax return.)

10. The undersigned warrants that he/she is empowered to execute this application on behalf of the above named
    applicant and certifies that the owner(s), partners, directors, corporate officers and operators listed herein are of
    good moral character. The undersigned further acknowledges awareness of and compliance with all of the
    requirements of Chapter 539.001, F.S., including the use of the approved pawnbroker transaction form and that
    the pawn service charge may not exceed 25% of the amount financed for each 30 day period.


     Print Name of Owner                                     Title



     Signature of Owner                                      Date

The foregoing instrument was acknowledged before me this ___________day of ____________. 20__________, by
________________________________________________, who is personally known to me or has produced
_____________________________ as identification and who did (did not) take an oath.


                            (SEAL)


                                                             Notary Public




DACS – 10111 Rev. 1/08
Page 3 of 6
 Florida Department of Agriculture and Consumer Services
 Pawnbroking Certificate of Deposit Assignment Form

“THIS SAMPLE IS A GUIDE TO DRAFTING, IS NOT INTENDED TO BE USED “AS IS” AND SHOULD
BE SUBMITTED ON BANK LETTERHEAD. NO CHANGES MAY BE MADE TO THE LANGUAGE
CONTAINED HEREIN.”


               PAWNBROKING CERTIFICATE OF DEPOSIT ASSIGNMENT FORM

(Name of person applying for Pawnbroker’s License), Assignor, does hereby assign, transfer, and set over unto the
Florida Department of Agriculture and Consumer Services, Assignee, all right, title and interest to and in
Certificate of Deposit Number _________________entitled __________________ and issued by (Name and
address of Depository), Depository, in the amount of $____________ (Principal sum), excluding interest payable
thereon. This assignment is made as security pursuant to Chapter 539, Florida Statutes, the Florida Pawnbroking
Act, for (Legal Name and address of Pawnshop – separate certificate of deposit or other security for each
location). This assignment includes any substitution or renewals to the Certificate of Deposit described, and shall
remain in effect until Assignee notifies Depository in writing of the cancellation of this assignment.

 Assignee is authorized to draw against the above Certificate of Deposit pursuant to the Florida Pawnbroking Act,
 and Depository is directed to pay-up to the Principal sum to assignee upon demand. Partial draft is permitted.
 Any payments made pursuant to this assignment shall constitute acquittance of Depository. Depository shall not
 pay any portion of Principal Sum to assignor without prior written cancellation of this assignment from the
 Assignee. This Certificate of Deposit may not be encumbered in any way, and any attempted encumbrance is
 void.

Signature of Assignor                                      Date


                       DEPOSITORY ACKNOWLEDGEMENT OF ASSIGNMENT
The Assignor’s sidnature above compares correctly with our files. Principal Sum is $___________, and the above
assignment will be considered valid and honored until written cancellation is received from Assignee.

Depository Name_____________________________________________________________________________

Address________________________________________ Telephone____________________________________

Name and Title of Authorized Depository Officer____________________________________________________


Signature of Authorized Depository Officer                 Date




 DACS – 10111 Rev. 1/08
 Page 4 of 6
Florida Department of Agriculture and Consumer Services
Pawnbroking Sample Net worth Affidavit

“THIS SAMPLE IS A GUIDE TO DRAFTING, IS NOT INTENDED TO BE USED “AS IS.” NO CHANGES
MAY BE MADE TO THE LANGUAGE CONTAINED HEREIN.”

Personal income tax returns do not include a listing of your assets and liabilities. If you are submitting a personal
income tax return as proof of a net worth of at least $50,000, please complete this balance sheet and return to the
Department.

STATEMENT OF ASSETS AND LIABILITIES FOR
As of __________________________20

               ASSETS

CURRENT ASSETS
Cash                                    $
Accounts receivable
Inventory
Prepaid expenses
Other current assets
         Total current assets                                                    $
FIXED ASSETS
Land and buildings (net)                $
Equipment (net)
Other fixed assets
          Total fixed assets                                                     $
OTHER ASSETS
Long-term investments                   $
Enter other assets here
Enter other assets here
          Total other assets                                                     $

Total Assets
                                                                                 $


                                            LIABILITIES AND EQUITY
CURRENT LIABILITIES
Accounts payable                        $
Short-term loans payable
Taxes payable
Other current liabilities




DACS – 10111 Rev. 1/08
Page 5 of 6
Florida Department of Agriculture and Consumer Services
Pawnbroking Sample Net worth Affidavit

       Total current liabilities                                        $
LONG-TERM LIABILITIES
Mortgage payable                        $
Long-term loans payable
Other long-term liabilities
          Total fixed assets                                            $
EQUITY
Net equity                              $
Retained earnings
            Total equity                                                $

Total liabilities and equity
                                                                        $


I hereby certify the above information to be true and accurate.


Please Print Name and Title


                         Signature                                              Date


The foregoing instrument was acknowleged before me this ________ day of _________,20 _______,
By _____________________________________, who is personally known to me or has produced
________________________________________ as identification and who did (did not) take an oath.




                          (SEAL)
                                                                            Notary Public




DACS – 10111 Rev. 1/08
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