Florida Departments Busines Professiorial Regulation rato Sey PAGE 7 RE: CASE NUMBER 2015013968 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO PETITIONER, VS. JOHNSON SUPER STOP LLC D/B/A JOHNSON SUPER STOP LICENSE NUMBER BEV1603228 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 JOHNSON SUPER STOP LLC 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: JOHNSON SUPER STOP LLC D/B/A JOHNSON SUPER STOP 6819 JOHNSON STREET HOLLYWOOD, FL 33024 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 §080 Coconut Creek Pkwy. www.MyFloridaLicense.com Fax: 954.917.1357 Suite C License Efficiently. Requiate Fairly. Margate FL 33063-3942 debra.nicoletti@myfioridalicense.com Florida Departmenta Busines Professidvral Regulation xen Lawson, Secretary PAGE 8 RE: CASE NUMBER 2015013968 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO VS. JOHNSON SUPER STOP LLC D/B/A JOHNSON SUPER STOP LICENSE NUMBER BEV1603228 You, JOHNSON SUPER STOP LLC, D/B/A JOHNSON SUPER STOP, are charged with the following count(s): 1. On or about June 9, 2015, you, the aforementioned licensee, holding a license issued by the Division of Alcoholic Beverages and Tobacco, or your agent(s), officer(s), servant(s), or employee(s), to wit: Rokshana Begum, did unlawfully and on your licensed premises dispense contact lenses without first being furnished a prescription, to wit: One pair of Fresh Look Color Blend Contact Lenses, Brown in Color, this act being contrary to and in violation of section 484.013(1)(c), Florida Statutes, within section 561.29(1)(a), Florida Statutes. 2. On or about June 9, 2015 you, the aforementioned licensee, holding a license issued by the Division of Alcoholic Beverages and Tobacco, or your agent(s), officer(s), servant(s), or employee(s), to wit: Rokshana Begum, did unlawfully and on your licensed premises dispense contact lenses when not being a licensed optician in the state of Florida, to wit: One pair of Fresh Look Color Blend Contact Lenses, Brown in Color, this act being contrary to and in violation of section 484.013(1)(b), Florida Statutes, within section 561.29(1){a), Florida Statutes. Signed this October 30, 2015 Thomas R. Philpot, Director Division of Alcoholic Beverages & Tobacco Carmen Puentes-Croye Law Enforcement Captain Explanation of Service: ‘U.S. Postal Servicer. © Date Served cp CERTIFIED MAIL: RECEIPT ; wie . (Domestic Mail Only; No insurance Coverage Provided) Received By oO a oe Tmation visit:our.website at www.usps.com, -- Personal Service By (sign) 2H 3 F Cc I A L. U S$ E rc . . Postage Personal Service By (print) 7 ru Certified Fee Py . o Postmark Service Location 3 (graeme Fee Here . . Restricted Dali Fat Certified Mail# 7012 1010 0002 0923 0664 o ee *Attach Receipt if Served by Mail. Fa Alas uu SpIeELYWOOD, FL 33024 qaLiser si7hisaa 5080 Coconut Cret = |offetektne Number 2015013968, riscdrionons Fax: 954.917.1357 Suite C Olly Siale, ARS — 7 Margate FL 3306'

Docket for Case No: 16-003297