Florida Department ~ Busines Professi ; Regulation : ken Lawson, Secreary PAGE 7 RE: CASE NUMBER 2013032364 . DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO PETITIONER, VS. CIBA INTERNATIONAL INC. D/B/A COLUMBIS FOOD AND BEVERAGE STORE LICENSE NUMBER BEV1614452 SERIES 2APS RESPONDENT ADMINISTRATIVE COMPLAINT Comes now, the Division of Alcoholic Beverages and Tobacco, herein after referred to as “petitioner,” and files this administrative complaint against CIBA INTERNATIONAL INC. herein after referred to as “respondent,” and alleges: 1. Petitioner is the state agency charged with supervising businesses licensed under the Florida beverage, tobacco and tax, and tobacco products permit laws pursuant to sections 559.061, 561.07, 561.15, 561.19, 561.29, 561.501, 210.15, 210.16, 210.45, 210.50, 569.003, and 569.006, Florida Statutes. 2. Respondent is, and has been at all times material hereto, the holder of a valid license/permit, issued in the State of Florida, by the Division of Alcoholic Beverages and Tobacco, Respondent's last known mailing address is as follows: CIBA INTERNATIONAL INC. D/B/A COLUMBIS FOOD AND BEVERAGE STORE 9061 PEMBROKE ROAD PEMBROKE PINES, FL 33025 And the division has not been notified of any other designated person or address for the service of process and notices authorized by Rule 61A-2.012, Florida Administrative Code. 3. Petitioner intends to revoke; suspend; annul; impose civil penalties, investigative costs, and late penalties; or any combination of these authorized penalties. This intended action is based on the below described facts or conduct. Tel 954.917.1346 5080 Coconut Creek Pkwy. www. MyFloridaLicense.com Fax: 954.917.1357 Suite © License Efficiently, Regulate Fairly. Margate FL 33063-3942 debra.nicoletti@myfloridalicense.com ia Rick Scott, Governor ie ulation. Ken Lawson, Secretary PAGE 8 RE: CASE NUMBER 2013032364 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO VS. CIBA INTERNATIONAL INC. D/B/A COLUMBIS FOOD AND BEVERAGE STORE LICENSE NUMBER BEV1614452 You, CIBA INTERNATIONAL INC., D/B/A COLUMBIS FOOD AND BEVERAGE STORE, are charged with the following count(s): 1. On or about January 24, 2013, January 31, 2013, and February 7, 2013, you, the aforementioned licensee, holding a license under the Beverage Law, or your agent(s), officer(s), servant(s), or employee(s), to wit: SK Arshad Ali (Owner), did unlawfully on your licensed premises, allow or permit the sale, possession, or consumption of an illegal controlled substance, to wit: Synthetic Cannabinoids (Spice)- chemical XLR-11((1-(5-fluoropenty!)-1H-indol-3-yl)(2,2,3,3- tetramethylcyclopropyl)methanone), this act being contrary to and in violation of section 893.13(1)(c), within 561.29(1)(a), Florida Statutes, Signed this December 12, 2013 Robert A. Douglas, Director Division of Alcoholic Beverages and Tobacco es A Carmen Puentes-Croye Law Enforcement Captain EXPLANATION OF SERVICE: DATE SERVED RECEIVED BY PERSONAL SERVICE BY (SIGN) PERSONAL SERVICE BY (PRINT) CERTIFIED MAIL # 7008 0500 0001 7330 3201 *ATTACH RECEIPT IF SERVED BY MAIL Tel 954.917.1346 5080 Coconut Creek Pkwy. MyFloriden Fax: 954.917.1357 Suite C License Efficiently. Regulate Fairly. Margate FL 33063-3942 debra nicoleti@myfloridalicense.com i i i i } { |

Docket for Case No: 14-001537