Questionnaire View - Beverage Law Institute

Name	Date of Birth	Age	Position Title	Date of Employment	Ever been Convicted?	Date of Conviction	Location	Type of Offense	Powers granted by Florida Legislature?	Statement of Affirmation	Signature
Brooke Runyon	04/18/1979	46	Manager	12/03/2024			n/a	n/a	No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Will Dorn	02/16/1995	30	Bartender	10/13/2017					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Melissa Zagkos	11/07/2000	24	Server	02/10/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
brianna france	11/30/2002	22	Server	04/25/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Kaia Galan	11/15/2002	22	Servers assistant	07/08/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Jennifer Rao	10/04/1980	44	Bartender	06/07/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Midera Keaney	10/27/1984	40	F and b server	08/13/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Edwin Justice	08/06/1950	75	security	09/11/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Jackson Wilks	07/13/2006	19	Server Assistant	06/22/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Karinsa Keaney	04/19/1982	43	Server	04/11/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Chris Johnson	03/30/1954	71	Bartender	02/01/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Yvonne Dufour	02/04/1985	40	Server	02/06/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Michael Cservenyak	10/12/1987	37	Server	03/21/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Alex Pena	01/30/2007	18	Essay	09/13/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Christine Green	07/27/1972	53	Server	01/22/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Samuel Obrien	02/14/2007	18	Server assistant	05/22/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Felix Alonzo	01/24/2004	21	Server assistant	04/24/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Johathan Saunders	11/17/2005	19	Sever Assistant	01/16/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Anibal Rosario	11/09/1995	29	server/bartender	07/25/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Patricia Chavez	11/15/2003	21	Hostess	10/13/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Jay Glover	09/26/1995	29	Bartender	09/02/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
DEVANI MONTANEZ KNIFFIN	09/07/2003	21	Bartender / cocktail server	05/20/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Daniel Fuentes	01/22/2005	20	Server	05/01/2025					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Kobi Hunter	01/15/1997	28	food runner/server	01/01/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Jitendra Rana	08/22/1993	32	F n B Server	06/27/2024					No	“I affirm under penalty of perjury as provided for in 559.791 and 837.06, F.S., that the foregoing information is true and correct to the best of my knowledge.”
Name	Date of Birth	Age	Position Title	Date of Employment	Ever been Convicted?	Date of Conviction	Location	Type of Offense	Powers granted by Florida Legislature?	Statement of Affirmation	Signature