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Certificate Number STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR A SANITATION CERTIFICATE AUTHORITY: Chapter 381, Florida Statue Instructions: 1. Provide the remainder of the information requested.

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How to fill out the Dh4086 online

Follow the steps to complete the Dh4086 application effectively.

  1. Press the ‘Get Form’ button to obtain the Dh4086 form and open it in your chosen digital format.
  2. In the 'Name of Facility' section, enter the legal name of your food service establishment.
  3. Provide the full address of your facility, including the street, city, state, and zip code.
  4. Fill in the 'Owner’s Name' section with the name of the person who owns the facility.
  5. Complete the 'Owner’s Address' field with the owner's full mailing address.
  6. Enter the contact number for the owner in the 'Owner’s Phone' field.
  7. Provide the 'Business Phone' number for the facility.
  8. Select the type of food service establishment from the provided options, such as school cafeteria, hospital, or mobile food unit.
  9. In the 'Comments/Special Instructions' section, include any additional information or special requirements pertinent to your operation.
  10. Specify the annual fee for your facility as indicated in the guidelines.
  11. Indicate the preferred payment method, ensuring not to send cash. Fill in the mailing address where the payment should be sent.
  12. Sign the application as the owner or owner's representative to confirm your agreement to comply with sanitary standards.
  13. Enter the date of signing in the designated field.
  14. If required, provide a signature from the Environmental Health representative, along with the date of the certificate.

Complete your Dh4086 application online today for a smooth submission process.

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Dh4086
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