Leon M. Biegalski, Director
Division of Pari-Mutuel Wagering
1940 North Monroe Street
Tallahassee, FL 32399-1035
Phone: 850.487.1395
Fax: 850.488.0550
- Statistical Information
- Licensing
- Rulemaking
- Track and Fronton Links
- Racing and Gaming Links
Greyhound Adoption Links - Exclusion List
- Contact the Division
Division of Pari-mutuel Wagering
PARI-MUTUEL WAGERING AND CARDROOMS FORMS CENTER
Pari-Mutuel Wagering and Cardroom Licensing
Permitholder Application Information
All of our user forms have been rendered enterable PDF files. You may either print them and fill them out as in the past—or you may now fill them out directly on your computer. You may not submit them online, but you can fill them out and print the filled out form.
NOTE: If you fill out a form using Adobe Acrobat Reader you will be able to save the blank form—but all of your data will be erased when you save it. One way around this is to save the blank form to your computer and fill it out using a different software program such as Foxit Reader (see link below).
Please be aware that forms occasionally change and insure that you are using the latest version of our form.
|
|
|
PERMIT FORMS
|
|
Permit Application |
|
Personal History Record |
|
Permit Transfer Application from one Existing Permitholder to Another Existing Permitholder |
|
Permitholder Application for Annual License and Operating Dates |
|
Permitholder Calendar |
|
Surety Bond For Florida Pari-Mutuel Wagering |
|
Permitholder Application for Annual License to Operate a Cardroom |
|
Officers and Directors |
|
List of Cardroom Business Occupational Licensees Providing Products and Services to a Cardroom |
|
|
|
|
LICENSING FORMS
|
|
Animal Owner's Temporary License Application |
|
Individual Occupational License Application |
|
Individual Occupational License Renewal Application (May only be used by people with a valid license that expired on June 30, 2011.) |
|
Business Occupational License Application |
|
Business Occupational License Renewal Application (May only be used by people with a valid license that expired on June 30, 2011.) |
|
License Upgrade Application |
|
Request for Waiver |
|
Officers and Directors |
|
Request for Release of Information and Authorization to Release Information |
|
General Explanatory Description |
|
Request for Address or Name Change |
|
Duplicate License Request |
|
|
|
|
OPERATIONS FORMS
|
|
Veterinary Report of Medication |
|
Request for Stay |
|
Request for Appeal of Stewards'/Judges' Ruling |
|
Veterinarian Report of Race-Day Salix Administration (SAMPLE) |
|
Notification to Stewards/Judges of Split Sample Request |
|
Bleeder's Certificate |
|
Request to Discontinue Salix |
|
Salix Certification Waiver |
|
Kennel Personnel Roster |
|
|
|
|
AUDITING FORMS
|
|
| Report of Escheated Outs | DBPR PMW-3510 |
| Notification of Pari-Mutuel Operations | DBPR PMW-3520 |
| Statement of Proceeds for Charity Day Performances | |
| Charity Day Proceeds and Distribution | DBPR PMW-3550 |
| Report of System Event or Malfunction | DBPR PMW-3580 |
| Notification of Interstate Broadcasting | DBPR PMW-3590 |
| Notification of Intertrack Wagering | DBPR PMW-3600 |
| Daily Tracking of Cardroom Jackpot (Excel file) | DBPR PMW-3605 |
| Totalisator System Checklist | DBPR PMW-3610 |
| Retired Jai Alai Players' Fund Distribution | DBPR PMW-3620 |
| Tickets Purchased and Cashed by the Totalisator Company | DBPR PMW-3630 |
| Cardroom Monthly Remittance Report (Excel file) | |
|
|
|
COMPLAINT FORM
|
|
Uniform Complaint Form |
|
|
|
Problems with blank or corrupt files?
NOTICE: By accessing the links below you will be leaving the DBPR website. DBPR is not responsible for the content of the website you are about to enter. DBPR neither warrants nor makes any representations nor endorsements as to the accuracy, quality, content or completeness of the information, text, images, graphics, hyperlinks and other items contained on the website you are about to enter. DBPR is not responsible or liable for any viruses or contaminations of your hardware, software, peripherals or property, resulting from use of websites linked to the DBPR website.
callcenter@myfloridalicense.com
please include "Pari-Mutuel Wagering" in the subject line.
Customer Contact Center 850.487.1395