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IMPORTANT THINGS TO REMEMBER WHEN COMPLETING AN APPLICATION (MyFloridaLicense)

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IMPORTANT THINGS TO REMEMBER WHEN COMPLETING AN
APPLICATION FOR REFUND
1. In the upper portion of the form, provide all information in the highlighted areas. Provide
an application, file and/or license number if applicable. In the Reason for Claim section,
indicate the reason for the refund, for example: overpayment of exam fees, duplicate
payments, etc… Failure to provide all required information may result in delay of
payment.
2. Print, - Sign, - and - Date - the application.
3. Mail the completed application to the address below that matches the area of licensure for
which you are requesting a refund:
For Accountancy:
Division of Certified Public Accounting
240 NW 76 Drives, Suite A
Gainesville, Florida 32607
For Real Estate:
Division of Real Estate
400 W. Robinson Street, Suite N-801
Orlando, Florida 32801-1757
For all others:
Department of Business and Professional Regulations
2601 Blair Stone Road
Tallahassee, Florida (use the applicable ZIP+4 Code from the chart below)
4.
Allow 3 to 4 weeks from the time the application is received by DBPR for review and
payment processing.
Pg 1 of 2
Profession/Division
Alcoholic Beverages and Tobacco
Architecture/Interior Design
Asbestos Licensing
Athlete Agents
Auctioneers
Barbers
Boxing Commission
Building Code Administrators & Inspectors
Child Labor
Community Association Managers
Condominiums, Timeshares & Mobile Homes
Profession/Division
Construction Industry
Cosmetology
Drug, Devices and Cosmetics
Electrical Contractors
Employee Leasing Companies
Florida Building Commission
Farm Labor
Geologists
Hotels and Restaurants
Home Inspectors 32399-2214
Labor Organizations
Landscape Architecture
Mold Related Services
Pari-Mutuel Wagering
Pilot Commissioners
Talent Agents
Veterinary Medicine
Important Note:
ZIP+4 Code
32399-1022
32399-0771
32399-0767
32399-0767
32399-0771
32399-0790
32399-1016
32399-0790
32399-2212
32399-0771
32399-1030
ZIP+4 Code
32399-1039
32399-0790
32399-1047
32399-0751
32399-0767
32399-0772
32399-2212
32399-0767
32399-1011
32399-2212
32399-0751
32399-2214
32399-1037
32399-0790
32399-0771
32399-0751
In order to process your refund, section 215.26, Florida Statutes, requires all requests for refunds
be submitted within 3 years of the initial payment to the State of Florida.
Pg 2 of 2
•
Form BPR AA-4
Rev. 12/16
Application for Refund
Pursuant to the provisions of Section 215.26, Florida Statutes, I hereby apply
for a refund, and that a State Warrant be drawn in the favor of:
For Agency Use Only
Payee:
Amount:
$
Object Refund
Address:
Code Amount
City: State: Zip:
$
Reason for Claim:
$
Phone#: Application,File or License#:
$
……………………………………………………………FOLD LINE………………………………………………………………………………………………
…
Certified true and correct this day of , X
Month
Year Applicant Signature
DO NOT WRITE BELOW THIS LINE-DBPR PERSONNEL ONLY
ACCOUNT NAME
FLAIR ACCOUNT CODE AUTHORIZED
STATUTE
PRTF 79-50-2-547001-79050100-00-000100
455.219
GENERAL REVENUE
PMW TAXES 79-74-1-000245-79100400-00-000300 550.09
OTP 79-74-1-000245-79400300-00-000320
565.12
OTP INTERNET TAXES 79-74-1-000245-79400300-00-000320 210.276
TRUST FUNDS
FLORIDA BOXING COMM. FEES 79-50-2-547001-79050400-00-000100
548.035
FLORIDA BOXING COMM. LICENSES 79-50-2-547001-79050400-00-000200
548.025
FLORIDA BOXING COMM. TAXES 79-50-2-547001-79050400-00-000300
548.06, 548.061
FLORIDA BOXING COMM. MISC 79-50-2-547001-79050400-00-000400
548.035
FLORIDA BOXING COMM. FINES & BONDS 79-50-2-547001-79050400-00-001200
548.014, 548.075
CHILD AND FARM LABOR 79-50-2-547001-79050600-00-000100 455
PMW TF FEES 79-20-2-520001-79100400-00-000100
550.09, 550.10
PMW TF LICENSES 79-20-2-520001-79100400-00-000200
550.09
PMW TF TAXES 79-20-2-520001-79100400-00-000300
550.09
PMW TF MISC 79-20-2-520001-79100400-00-000400
550.09
PMW TF FEES 79-20-2-520001-79100400-00-001200
550.09, 550.10
SLOT COM/ADDICTIVE GAMBLING 79-20-2-520001-79100500-00-000130
550.09, 550.10
SLOT GENERAL OCC. LICENSE 79-20-2-520001-79100500-00-000132
550.09
SLOT BUSINESS OCC. LICENSE 79-20-2-520001-79100500-00-000133
550.09
SLOT PROFESSIONAL OCC. LICENSE 79-20-2-520001-79100500-00-000134
550.09
SLOT TAXES 79-20-2-520001-79100500-00-000335
550.09, 550.10
SLOT FINES 79-20-2-520001-79100500-00-001200
550.09, 550.10
SLOT MISCELLANEOUS REVENUE 79-20-2-520001-79100500-00-000400 550
H & R FEES 79-50-2-375001-79200100-00-000100
509.251, 509.261, 509.3
H & R LICENSES 79-50-2-375001-79200100-00-000200
509.251, 509.261, 509.3
H & R MISC 79-50-2-375001-79200100-00-000400
509.251, 509.261, 399.0
H & R FINES 79-50-2-375001-79200100-00-001200
509.251, 509.261, 399.0
DIV OF FLORIDA CONDOMINIUMS-FEES 79-50-2-289001-79800100-00-000100
498.017
DIV OF FLORIDA CONDOMINIUMS-LICENSE 79-50-2-289001-79800100-00-000200
498.017
DIV OF FLORIDA CONDOMINIUMS-MISC 79-50-2-289001-79800100-00-000400
498.017
DIV OF FLORIDA CONDOMINIUMS-FINES 79-50-2-289001-79800100-00-001200
498.017
AB&T FEES 79-20-2-022001-79400300-00-000100
561.19, 563.564, 565.02
AB&T LICENSE 79-20-2-022001-79400300-00-000200
561.19, 563.564, 565.02
AB&T TAXES 79-20-2-022001-79400300-00-000311
561.12
AB&T MISC 79-20-2-022001-79400300-00-000400
561.19, 563.564, 565.02
AB&T FINES 79-20-2-022001-79400300-00-001200
561.19, 563.564, 565.02
CIGARETTE TAX COLL.-TAXES. 79-74-2-086001-79400300-00-000312
210.04
CIGARETTE SURCHARGE 79-20-2-086001-79400300-00-000313 210.011
OTP SURCHARGE 79-20-2-086001-79400300-00-000319 210.011
Validation #: LicenseEase Year:
Certified true and correct this________day of _______________, 20__________
mm/dd/yyyy
Organization Code:
Signature of Authorized Agency Person Title
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IMPORTANT THINGS TO REMEMBER WHEN COMPLETING AN APPLICATION (MyFloridaLicense)

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Completed 12 July 2021

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