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