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					Jewelry Manufacturer in Winter
Springs, Florida
3 licenses required


Overview
We researched your case and found 3 licenses and permits that are either required or optional for your
business in Winter Springs , Florida. Note that some licenses and permits may be optional, depending on
your particular business situation. Please see the details for each license and/or permit to determine whether
it applies to your case.


If you have any questions, you can call our License123 support line at (888) 752-4111.
Table of Contents

Required
City of Winter Springs

 1   Winter Springs Business Tax Receipt

Seminole County

 2   Seminole County Business Tax Receipt

State of Florida

 3   Florida Business Tax License
    1 Winter Springs Business Tax Receipt

Description
Every business in Winter Springs is required to submit a Business Tax Application.

Renewal information: 1 year




Application Process
Submit required application to City of Winter Springs.


Prices and Fees
Permit Cost:
No fee.


Where to File
1126 East State Road
Winter Springs, Florida 32708

Fax: (407)327-4784
Phone: 407-327-1800
                                                     CITY OF WINTER SPRINGS, FLORIDA
                                                           1126 EAST STATE ROAD 434
                                                       WINTER SPRINGS, FLORIDA 32708-2799
                                                        Telephone (407) 327-1800 Fax (407)327-4784

                                                      CITY OF WINTER SPRINGS/SEMINOLE COUNTY
                                                         BUSINESS TAX RECEIPT APPLICATION

GENERAL INSTRUCTIONS: This application must be completed and signed. The applicant may not operate or engage in business until the Business Tax is paid.
Any profession requiring state licensing, certification, or registration is required to be presented to the City of Winter Springs prior to receiving a business tax
receipt.
BUSINESS NAME:

BUSINESS LOCATION ADDRESS:                                                               SUITE:

CITY/STATE/ZIP:

PHONE:                                        FAX:                                             EMAIL:

MAILING ADDRESS (if different than location address):

CITY/STATE/ZIP:

BUSINESS OPENING DATE (in Winter Springs):                                               FEDERAL EMPLOYER ID # OR SOCIAL SECURITY #:

NOTICE: Pursuant to Florida Statue 119.071(5), the City of Winter Springs is required to collect your social security number for production of a local business tax
receipt when a federal identification number is not provided. All information is subject to public record except for social security numbers.
OWNER/OFFICER LAST NAME:                                                                    FIRST NAME:

HOME ADDRESS:                                                                            CITY/STATE/ZIP:

PHONE:                                                        FAX:                                                 EMAIL:

DRIVER LICENSE NUMBER:                                        STATE:                EXPIRATION DATE:                          DATE OF BIRTH:

NATURE OF BUSINESS:




CHECK THE FOLLOWING THAT APPLIES:
    NEW HOME OFFICE ONLY                         NEW COMMERCIAL                      TRANSFER
If Transfer Check One: Name Location              Owner                           TRANSFERRED FROM:

ADDITIONAL                    STATE LICENSE NUMBER:               FICTITIOUS NAME AND/OR CORPORATION NUMBER: SALES TAX NUMBER:
REQUIREMENTS:
(Attach Copies)
FICTITIOUS NAME EXEMPTION INFORMATION: By affixing my name and signature below, I understand that I am affirming that my business or profession is
exempt from the Fictitious Name Registration as defined in Florida Statutes Section 205.023 for this reason:
   Licensed attorney forming a business for the practice of law in the state of Florida.
   Registered with the Department of Business and Professional Regulation or the Department of Health and their licensing board have not imposed requirements
for the registration as a fictitious name.
   Corporation, partnership or other legal entity filed or registered and in good standing with the Division or Corporations and is not transacting business under any
other name.
   Name(s) (first and last) of the owner(s) is/are the business name.




                                                                                                                                                Page 1 of 2
                                           CITY OF WINTER SPRINGS, FLORIDA
                                                 1126 EAST STATE ROAD 434
                                             WINTER SPRINGS, FLORIDA 32708-2799
                                              Telephone (407) 327-1800 Fax (407)327-4784

                                            CITY OF WINTER SPRINGS/SEMINOLE COUNTY
                                               BUSINESS TAX RECEIPT APPLICATION


COMMERCIAL BUSINESS USAGE/UNIT/FEE INFORMATION:
  Retail/Wholesale/Service/Office:            Number of Employees:_______________
  Restaurant/Lounge:                          Number of Seats: _______________
                                              Serving Alcoholic Beverages:   Yes    No
  Schools/Daycare/Group Home:                 Number of Students/Residents/Beds:_______________
  Rentals (Residential/Commercial):           Number of Units: _______________ Square Footage:_______________
  Vending:                                    Number of Vending/Coin-Operated Machines/ATM’s:_______________
  Taxicab/Limousine:                          Number of Vehicles:_______________




        CERTIFICATION: I swear or affirm that the information contained herein is true and correct to the best of my
        knowledge and belief. I acknowledge that payment of the business tax does not waive the requirements of any City,
        County, State, or Federal ordinance, statute, rule or regulation that I must meet prior to entering into the business or
        profession for which the business tax is paid, nor does payment of the tax indicate that my place of business has any
        appropriate zoning or land development approvals. I acknowledge that I must contact Code Enforcement to determine
        the need for a zoning verification letter, site development order, building permit and/or certificate of
        completion/occupancy. I acknowledge that the City of Winter Springs Traffic Ordinance prohibits parking within the
        right of way of any road for the purpose of selling merchandise or services.




                                         __________________________________________________
                                                           Signature of Applicant




                                         __________________________________________________
                                                         Printed Name of Applicant




                                                       ________________________
                                                                   Date




                                  THE CITY OF WINTER SPRINGS WELCOMES YOUR BUSINESS!




                                                                                                                       Page 2 of 2
    2 Seminole County Business Tax Receipt

Description
All businesses located in Seminole County must have a business tax receipt.

Renewal information: 1 Year




Application Process
Submit completed application and application fee to the Seminole County Tax Collector.


Prices and Fees
Permit Cost:
Full year (Applying between July 1 and March 31)
Not Regulated - $25.00
Regulated - $45.00

Half year (Applying between April 1 and June 30)
Not Regulated - $12.50
Regulated - $22.50
If doing a regulated business, please provide a copy of state business license.


Where to File
Seminole County Tax Collector
Attn: Business Tax Department
PO Box 630
Sanford, FL 32772-0630
Phone: 407-665-7636
                                           SEMINOLE COUNTY TAX COLLECTOR
                                      BUSINESS TAX RECEIPT APPLICATION
                                                                 (407) 665-7636

 BUSINESS LOCATION INFORMATION                                                   MAILING INFORMATION
             *No PO Box or PMB Permitted                                        Check Here if Same as Business Location
Name:                                                                Name:


Address:                                                            Address:
City:                                                    FL         City:                                           State:
Zip:                                                                Zip:

NEW BUSINESS INFORMATION:
Phone:                                                            Business Start Date:
Federal ID #:                                                    OR SS #:
                               (Social Security # Not Required If Federal ID Provided. Fl. Statute 205.0535-[5])
Business Description (Explain in Detail):

Full Year Fee (Applying between July 1 & March 31):                  Not Regulated $25.00                Regulated** $45.00
Half Year Fee (Applying between April 1 & June 30):                  Not Regulated $12.50                Regulated** $22.50
EXISTING BUSINESS CHANGES/TRANSFERS:                      Current Account #:
Upgrade:            $20.00 (Not Regulated to Regulated**)         Duplicate BTR: $ 3.00
Transfer:           $ 3.00 (Business Name, Location *, Ownership Changes, etc.)
                Please Specify Changes:___________________________________________________________________
* Call 407-665-7636 first if Transfer involves a change in location.
**All “Regulated” business entities must present a copy of the state license or certification.
                      Owner(s), Professional, or Officer of Corporation Information
Name of Individual:                                                        Title:
Home Address:                                                              Home Phone:


City:                                                                      State:                          Zip:

  If applicable, complete the following:
  Fictitious Name Registration #:
                                                        (If Required, please attach a copy of the Fictitious Name Registration)

  Regulatory License/Certification #:
                                                                  (Please attach copy of Licensing Documentation)

  Corporate Doc #:
                                                 (Please attach a copy of the Florida Corporation Charter page)

  Note: It is the responsibility of all businesses located in unincorporated Seminole County to receive zoning
  approval prior to conducting any type of business. Contact the COUNTY PLANNING DEPARTMENT
  (407-665-7444) to check zoning requirements for your location. Note: Seminole County zoning rules require the
  business owner to reside at the location where a residential address is used. Proof of residency is required.
Rev. 08/12                                                        (over)
                                Fictitious Name Exemption Information
        By affixing my name and signature below, I understand that I am affirming that my business or
profession is exempt from the Fictitious Name Registration as defined in Florida Statutes Section 205.023 for
the reason indicated:
             □   Licensed attorney forming a business for the practice of law in the state of Florida.
             □   Registered with the Department of Business and Professional Regulation or the Department of Health
                 and their licensing board has not imposed requirements for the registration as a fictitious name.
             □   Corporation, partnership or other legal entity filed or registered and in good standing with the Division of
                 Corporations and is not transacting business under any other name.
             □   Name(s) (first and last) of the owner(s) is/are the business name.

****************************************************************************
     All information is subject to public record except for social security numbers.
         Under penalty of perjury, I certify that the foregoing information is, to the best of my knowledge and
belief, true and accurate.
        I acknowledge that a Tax Receipt issued pursuant to this application does not waive requirements of any
city, county, state or federal ordinance, statute or regulation that I must meet prior to entering the business,
profession or occupation for which the Receipt is sought. I have or will comply with all such requirements.
        I specifically acknowledge that a Business Tax Receipt issued pursuant to this application does not
indicate that the parcel of land upon which I intend to operate is properly zoned for the activity I intend. It is
MY RESPONSIBILITY TO VERIFY COMPATIBLE ZONING WITH THE APPROPRIATE ZONING
AUTHORITY PRIOR TO COMMENCING OPERATIONS.
     Similarly, I acknowledge that the SEMINOLE COUNTY TRAFFIC ORDINANCE PROHIBITS
PARKING WITHIN THE RIGHT-OF-WAY of any road for the purpose of selling merchandise or services.


                                  _______________
                                      Date                          Owner(s), Professional, or Officer Signature


                                                                            Printed Name and Title

                            MAKE CHECK PAYABLE “Ray Valdes, Tax Collector”.

                                      APPLICATIONS MAY BE MAILED TO:
                                      Ray Valdes, Seminole County Tax Collector
                                               Attn: Business Tax Dept.
                                                     PO Box 630
                                            Sanford, Florida 32772-0630

                                                              or

             Presented at any of our five office locations 8:30 a.m. to 5:00 p.m. Monday through Friday.

 County Services Building      Wilshire Plaza           Oak Groves Shoppes        ShelMar Prof’l Building   Commons at Primera
   1101 E First Street        384 Wilshire Blvd        995 N SR 434 Suite 505     1490 Swanson Dr #100       845 Primera Blvd
    Sanford, FL 32771       Casselberry, FL 32707   Altamonte Springs, FL 32714     Oviedo, FL 32765        Lake Mary, FL 32746

Rev. 08/12
                                   SEMINOLE COUNTY TAX COLLECTOR'S
                              INFORMATION GUIDE FOR NEW BUSINESS OWNERS
                                                          www.seminoletax.org
        As a new business owner, there are many regulatory items you should know. This guide is just a brief
        introduction to the most common issues and should not be relied upon as an all inclusive document.

SPECIAL NOTES:
     • The Tax Collector must be notified of any business or mailing address change.
          • If a change of business ownership has taken place, a signed bill of sale must be presented to the Tax Collector’s
              Office in order to transfer or renew the existing Business Tax Receipt.
          • To conduct a “Going Out of Business Sale” you must obtain a permit. Call 407-665-7644 for more information or
              visit our website www.seminoletax.org.
          • A fine of $250 may be added to any County Business Tax Receipt not obtained or renewed within 150 days of
              initial notice of tax due.
LOCAL LEVEL:
  1.      Business Tax Receipts are required and issued to businesses operating within the boundary of Seminole County.
          Businesses located within any of our 7 cities will also need a Business Tax Receipt from that city. The city Receipt
          should be obtained prior to the Seminole County Business Tax Receipt to assure approved proper local zoning.

          Below are the seven city offices in Seminole County with addresses and phone numbers. If your business is
          located within the Cities of Altamonte Springs, Casselberry, Longwood, Oviedo, and Winter Springs,
          you will be issued both the city and county Business Tax Receipts at one time within the respective
          City Hall. We encourage the other two cities to offer this one-stop service in the future.
                           Altamonte Springs               202 Newburyport Avenue              407-571-8116
                           Casselberry                     95 Triplet Lake Drive               407-262-7700
                           Lake Mary                       100 N. Country Club Road            407-585-1415
                           Longwood                        155 W. Warren Avenue                407-260-3442
                           Oviedo                          400 Alexandria Blvd.                407-971-5755
                           Sanford                         300 N Park Avenue                   407-688-5150
                           Winter Springs                  1126 E SR 434                       407-327-1800
          The fee for the Seminole County Business Tax Receipt is $25 for all non-regulated licenses, and $45 for all
          regulated entities. “Regulated” businesses are defined as those requiring local, state, professional, or federal
          license or certification. Regulated businesses will be required to show proof of all required regulatory license or
          certification prior to being issued a Business Tax Receipt.

  2.      All Seminole County Business Tax Receipts expire September 30th of each year. Certain Business Tax Receipts
          issued by the County may be renewed online (www.seminoletax.org), by mail, or obtained at any of the following
          Tax Collector locations:
            Sanford Office         Casselberry Office         Altamonte Springs Office       Oviedo Office        Lake Mary Office
       County Services Building     104 Wilshire Blvd            Oak Groves Shoppes      1490 Swanson Dr #100    845 Primera Blvd
         1101 E First Street      Casselberry, FL 32707        995 N SR 434 Suite 505      Oviedo, FL 32765     Lake Mary, FL 32746
          Sanford, FL 32771                                   Altamonte Spgs, FL 32714

  3.      It is the responsibility of all businesses located in unincorporated Seminole County to receive zoning approval prior
          to conducting any type of business. Contact the COUNTY PLANNING DEPARTMENT (407-665-7444) to check
          zoning requirements for your location. Note: Seminole County Zoning rules require the business owner to reside at
          the location where a residential address is used. Proof of residency is required.

  4.      To occupy an existing building the new tenant must contact the County Building/Fire Division (407-665-7050) to
          verify approved occupational business use prior to occupying the building. All new commercial business locations
          that have never been occupied will require an occupancy/interior completion permit before the building is occupied.
          City Fire and Building Departments have jurisdiction over businesses within city limits.

  5.      Businesses providing electricity, water, metered or bottled gas, telecommunications services, or fuel oil, are
          required to collect a Public Service Tax on the sale of such items or services in unincorporated Seminole County.
          Contact County Fiscal Services (407-665-7176) for detailed information and forms.


Revised 9/24/13
  6.     Any person or entity who rents or leases any accommodation for six months or less must enroll and remit payment
         for the Seminole County Tourist Development Tax each month. This tax applies to hotels, motels, apartment
         buildings, bed and breakfast facilities, single or multi-family dwellings, condominiums, mobile home parks, and
         vessels. Detailed information regarding this tax is available on our website, www.seminoletax.org.

  7.     All businesses must file a Tangible Personal Property Tax Return annually with the office of the Seminole
         County Property Appraiser before April 1st of each year (407-665-7506). (www.scpafl.org)

              •   Personal Property taxes are assessed on your business equipment and furniture as of January 1, and
                  become payable November 1. Taxes become delinquent as of April 1. After that a Tax Warrant is issued.
              •   Personal property taxes follow the equipment, NOT the owner. When purchasing an existing business,
                  make sure the tangible taxes have been paid in full for prior and current year. (407-665-7608)
              •   If you discontinue your business, contact this office at 407-665-7608 and the Property Appraiser’s Office at
                  407-665-7506 as soon as possible to avoid additional cost and fees.
  8.     Small business information: Small business development seminars are available through the Seminole State
         College of Florida in Sanford (407-321-3495) (http://sbdc.seminolestate.edu). Federal forms, licenses, permits, and
         regulatory information is available at www.sba.gov.

STATE LEVEL:

  9.     The Florida Department of Revenue issues State Sales Tax numbers. Their local office is located at 2301 Maitland
         Center Parkway, Suite 160, Maitland, FL 32751. (407-475-1200; 800-352-3671) (http://dor.myflorida.com)
 10.     Online information and filing is available at www.sunbiz.org for the following required state registrations:
              •   Fictitious Name Registration (per Florida Statute Section 865.09). Anyone conducting business and using
                  a business name that does not fall under the State of Florida exempt guidelines must register their
                  business name. (850-245-6058).
              •   All corporate registrations. (850-245-6052).
 11.     State licensing requirements for:
         •    Daycares, Preschools, and Adoption agencies can be obtained through the Florida Department of Children
              and Families (407-317-7820). (www.myflfamilies.com)
         •    Restaurants, Alcohol sales, and Mobile/Perishable Food Carts can be obtained through the Division of Hotel
              & Restaurant Commission (850-487-1395). The Division of Hotel & Restaurant Commission is located in
              the Hurston Building, North Tower, 400 W. Robinson St, Orlando, FL 32801.
              (www.myfloridalicense.com/dbpr)
         •    Convenience/Grocery Stores, Health Clubs, Automotive Repair Businesses, Travel Agencies, Moving
              Companies, Bakeries, Delicatessens, or Agriculture Products can be obtained through the Department of
              Agriculture and Consumer Services (1-800-435-7352). (www.freshfromflorida.com)
         •    Salons, Accounting, Real Estate, or Construction Industry Professions can be obtained by calling the
              Department of Business and Professional Regulations (850-487-1395).
              (www.myfloridalicense.com/dbpr)
         •    Finance, Investments, Mortgage, and Banking Professions can be obtained by calling the Office of Financial
              Regulations (850-487-9687). (www.flofr.com)
 12.     For Worker’s Compensation information, call the Department of Financial Services Customer Service line
         (850-413-1609) or the Orlando office (407-835-4406). (www.myfloridacfo.com/wc/)

FEDERAL LEVEL:

 13.     The Internal Revenue Service issues the Federal I.D. numbers. (1-800-829-4933). (www.irs.gov)
 14.     Pertinent information on starting a business is available at www.irs.gov/Forms-&-Pubs.

                     FOR ANY ADDITIONAL INFORMATION, PLEASE CONTACT THE
                  OFFICE OF THE SEMINOLE COUNTY TAX COLLECTOR AT 407-665-7638.

Revised 9/24/13
                              NEW BUSINESS CHECKLIST


       Seminole County Occupational Business Tax Receipt Application completed and signed by
       an owner, partner, or officer of the corporation, or LLC.

       A Social Security or Federal ID number (Required by FL Statute 205.0535-[5]).

       Florida Corporation Charter page (Required if the business is incorporated).

       Fictitious Name Registration issued by the Florida Secretary of State (Required if business
       uses a name other than the owner’s legal name or a corporate name).

       If the business is located within the city limits of Lake Mary or Sanford, it is recommended
       that you obtain the city business tax receipt prior to applying for the county tax receipt.

       Required Local, State or Federal license for regulated businesses as stated in the Seminole
       County Code.

       Bill of Sale and original (current year) Seminole County Occupational Business Tax Receipt
       (Required for the transfer of ownership of an existing business).

       Florida Sales Tax Number. (This is required by the Florida Department of Revenue. Your
       Seminole County Business Tax Receipt can be issued if you have not received the number,
       however, we strongly suggest that you make application to the Department of Revenue.)

NOTICE: It is the responsibility of all businesses located in unincorporated Seminole County to
receive zoning approval prior to conducting any type of business. Contact the COUNTY
PLANNING DEPARTMENT (407-665-7444) to check zoning requirements for your location.

NOTE: SEMINOLE COUNTY ZONING RULES REQUIRE THE BUSINESS OWNER TO
RESIDE AT THE LOCATION WHERE A RESIDENTIAL ADDRESS IS USED. PROOF OF
RESIDENCY IS REQUIRED.

VERY IMPORTANT NOTE:

All businesses within the state must file an annual Tangible Personal Property Tax Return with
the County Property Appraiser on equipment used in the operation of the business. You may
visit the Seminole County Property Appraiser website at www.scpafl.org to download a sample
return with general instructions. However, it is suggested that you contact the Property
Appraiser’s Office at 407-665-7538 for specific first time filing instructions.

If you have any questions regarding any of the requirements or the process of applying for a
Seminole County Business Tax Receipt, please contact our office at 407-665-7638.



                       The Seminole County Tax Collector
                                  WELCOMES YOU!


RV 07/12/13
                                                   SEMINOLE COUNTY TAX COLLECTOR

                                          BUSINESS TAX RECEIPT EXEMPTION FORM
                                                              Telephone: 407-665-7638
Florida Statutes 205.162, 205.192, and 205.171 provide certain exemptions from the Business Tax Receipt fee.
Please check the appropriate exemption box, attach all required documents, and submit this form along with the
Seminole County Business Tax Receipt Application.

        F.S. 205.162: Exemption for certain disabled persons, the aged, and widows with minor dependents-
          All disabled persons physically incapable of manual labor, widows with minor dependents, and persons 65 years of
          age or older:
                     with not more than one employee or helper, and
                     who use their own capital only, not in excess of $1,000,
          may engage in any business or occupation in counties in which they live without being required to pay a business tax.
          The exemption provided by this section shall be allowed only upon the certification of a reputable physician, stating
          that the applicant claiming the exemption is disabled, along with the nature and extent of the disability.
          In case the exemption is claimed by a widow with minor dependents, or a person over 65 years of age, proof of the
          right to the exemption shall be made.

    F.S. 205.192: Charitable, etc., organizations; occasional sales, fundraising; exemption-
          A business tax receipt is not required of any charitable, religious, fraternal, youth, civic, service, or other similar
          organization that makes occasional sales or engages in fundraising projects that are performed exclusively by the
          members, and the proceeds derived from the activities are used exclusively in the charitable, religious, fraternal,
          youth, civic, and service activities of the organization.

    F.S.205.171: Exemptions allowed disabled veterans of any war or their unremarried spouses-
    •     Any bona fide, permanent resident of Florida who served as an officer or enlisted person during any of the periods
          specified (identified in s. 1.01[14]) in the Armed Forces of the United States, National Guard, or US Coast Guard or
          Coast Guard Reserve, who was honorably discharged, and who at the time of his or her application for a business
          tax receipt is disabled from performing manual labor shall, upon sufficient identification, be granted a receipt to
          engage in any business or occupation in the state which may be carried on mainly through the personal efforts of the
          receiptholder as a means of livelihood when the state, county, or municipal tax receipt does not exceed the sum of
          $50, or be entitled to an exemption to the extent of $50 when the state, county, or municipal tax receipt for such
          business or occupation is more than $50.
    •     If the business tax exceeds the sum of $50, the remainder of such business tax in excess of $50 shall be paid.
    •     Such license shall be marked "Veterans Exempt Receipt"--"Not Transferable."
    •     The proof may be made by establishing to the satisfaction of such tax collecting authority by means of a certificate of
          honorable discharge or certified copy that the applicant is a veteran by exhibiting one or more of the following:
            (a) certificate of government-rated disability to an extent of 10 percent or more;
            (b) The affidavit or testimony of a reputable physician who personally knows the applicant and who makes oath
                  that the applicant is disabled from performing manual labor as a means of livelihood;
            (c) The certificate of the veteran's service officer of the county in which applicant lives attesting the fact that the
                  applicant is disabled and entitled to receive a tax receipt within the meaning and intent of this section;
            (d) A pension certificate issued to him or her by the United States by reason of such disability; or
            (e) Such other reasonable proof to establish the fact that such applicant is disabled.
    •     The unremarried spouse of a deceased disabled veteran of any war in which the United States Armed Forces
          participated is entitled to the same exemptions as the disabled veteran.

NOTE: In no event, under this or any other law, shall any person, veteran or otherwise, be allowed any exemption
whatsoever from the payment of any amount required by law for the issuance of a Business Tax Receipt to sell
intoxicating liquors or malt and vinous beverages.




                       Name                                                 Signature                                  Date
RV07/12/13
     3 Florida Business Tax License

Description
Before you begin business in Florida, you must first find out if your business activity, products used or things
that you will be selling are subject to sales or use tax. If it is, you must register to collect sales tax or pay use
tax.

Renewal information: 1 Year




Form Instructions
- Sales and Use Tax Return
http://dor.myflorida.com/dor/forms/2012/dr15.pdf

Online Application Available: https://taxapps3.state.fl.us/Iregistration/


Application Process
Businesses whose sales and use tax collections are less than $20,000 per year may pay and report tax using
a paper Sales and Use Tax Return (Form DR-15).

** Check to see if the services offered by your business qualify for Florida sales tax registration **

http://dor.myflorida.com/dor/taxes/sales_tax.html

Questions can be answered by your local taxpayer service center

http://dor.myflorida.com/dor/taxes/servicecenters.html

Note:
If online application is not working, try opening with a different browser.


Prices and Fees
Permit Cost:
Activities Subject to Solid waste Fees & Surcharge (dry-cleaning fee applies) - $30.00

Activities Subject to Sales & use Tax (fee for in-state business/rental locations) - $5.00


Where to File
Florida Department of Revenue
Account Management - Mail Stop 1-5611
5050 W Tennessee St
Tallahassee FL 32399-016
Phone: 800-352-3671
                  Florida Business Tax Application
                                                                                                                                                                                       DR-1
                                                                                                                                                                                    R. 07/11
                  (Formerly, Application to Collect and/or Report Tax in Florida)                                                                                                    Page 1
                                                                                                                                                                                Rule 12A-1.097
                                                                                                                                                                    Florida Administrative Code


Register online at your convenience. our Internet site guides you
through an easy step-by-step interview. our free online registration
                                                                                                                               For DoR use only
is secure and saves you paper, postage, and time.


                                                                           Our Internet site is at www.myflorida.com/dor

Please read the Instructions for Completing the Florida Business Tax Application (Form DR-1N). Every applicant must complete Sections A and J and must
answer the questions in bold print at the beginning of every section and subsection. This application will be rejected if the required information is not provided.
 Section A – Reason for Applying and Applicant Information
 1.    Indicate your reason for submitting this application (check only one; provide date and certificate number, if applicable).
        a. New business entity.                               Beginning date of Florida business activity:

        b.    New/additional Florida business location.       Beginning date of business activity at new Florida location:

                                                                   Link new location to existing
                                                                   consolidated filing number:                      8 0–                                                              –
        c.    New taxable activity at previously              Date of new taxable activity:
              registered business location.
        d.    Change of Florida county.                       Date of location county change:

                                                              Old location’s certificate/account
                                                                                                                           –                                                          –
                                                              number:
                                                                    Link new county location to
                                                                    existing consolidated filing number:            8 0–                                                              –
        e.    Change of legal entity/business structure.      Date of legal entity change:

                                                              Old entity’s certificate/account number:                     –                                                          –
        f.    Purchase/acquisition of existing business       Date of purchase/acquisition:
              from another person or entity.

 2. Is this a seasonal business? Yes                       No If yes, first month of season: _____________________ last month: _____________________
BuSIneSS enTITy InFoRmATIon
 3a. Legal name of individual owner Last name:                                 First name:                  Middle name/initial:                3b. Owner’s telephone number:
     (for sole proprietor only):                                                                                                                (    )
 3c. Legal name of business entity (corporation, limited liability company, partnership, trust, estate, etc.):


 4.   Trade, fictitious, or “doing business as” name:


 5a. Physical street address of business location or rental property being registered (see instructions):                                       5b. Business telephone number:
                                                                                                                                                (    )
      City/State/ZIP:                                                                                       County:                             5c. Fax number:
                                                                                                                                                (    )
 6.   Mail to the attention of:                                                Mailing address (if different from # 5a):


      City/State/ZIP:


 7.   E-mail address:
      Your e-mail address is treated as confidential information [section (s). 213.053, Florida Statutes (F.S.)], and is not subject to disclosure of public records (s. 119.071, F.S.).
 8a. Business Entity Identification Number - Provide the Federal Employer Identification                    8b. FEIN:                           8c. SSN*:
     Number (FEIN) of the business entity or Social Security Number (SSN)* of the owner/sole
     proprietor. Sole proprietors employing workers must also have an FEIN.
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    9.      If you checked Box 1.f. because you purchased or acquired an existing business from another person or entity, provide the following information about the
            other person or entity:
    a. Legal name of person or entity:                                                                         b. FEIN:                                 c. Unemployment tax account number:

    d. Address, City, State, ZIP:                                                                                                                       e. Sales tax certificate number:

    f. Portion of business acquired:                                                                           g. Date of purchase or acquisition:
                                                                  All           Part          Unknown

    h. Was the business operating at the time of purchase/                                                     i. If no, on what date did the business close?
       acquisition?                                                                     Yes       No

    j. Did the business have employees at the time of                                                          k. If yes, did you acquire the employees?
       purchase/acquisition?                                                            Yes       No                                                                          Yes          No

    l. Did the acquired entity and your entity share any common ownership, management, or control at the time of purchase/acquisition?                                        Yes             No

BuSIneSS STRuCTuRe & owneRShIP
    10. Check the box next to the structure of your business entity.
            a. Sole proprietorship                                                                      d. Limited liability company (check one                    g. Estate
                                                                                                        below)
            b. Partnership (check one below)                                                                                                                       Provide date of death:
                                                                                                              Single member LLC
                   Married couple                      General partnership
                                                                                                              Multi-member LLC
                   Limited partnership                 Joint venture                                                                                               h. Government agency
                                                                                                              Check if you elected to be treated as
            c. Corporation (check one below)                                                                  a corporation for federal income tax                 i. Indian tribe or Tribal unit
                                                                                                              purposes.
                   C-corporation                       Not-for-profit corporation
                                                                                                        e. Business trust
                   S-corporation
                                                                                                        f. Nonbusiness trust/Fiduciary


    11. Corporations, partnerships, limited liability companies, and trusts must provide the following:
    a.      Document number issued by the Florida Secretary of State when the entity was                                    Document number:
            chartered or authorized to conduct business in Florida:

    b.      Date of Florida incorporation, formation or organization, or date of authorization to conduct business in Florida:


    c.      Entity’s fiscal year ending date (month/day):


    12. Identify the owner/sole proprietor, or officers, general partners, managing members or trustees of the business entity.
Name:                                            Social Security Number*:                                 Home address:                                                   Percent of ownership/control:


Title:                                           Driver license number/Issuing state:                     City/State/ZIP:                                                 Telephone number:
                                                                                                                                                                          (           )
Name:                                            Social Security Number*:                                 Home address:                                                   Percent of ownership/control:


Title:                                           Driver license number/Issuing state:                     City/State/ZIP:                                                 Telephone number:
                                                                                                                                                                          (           )
                                                                                                (Attach additional pages, if necessary)
*        Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs obtained for tax administration purposes are confidential under
         sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection of your SSN is authorized under state and federal law. Visit our Internet site at www.myflorida.com/dor
         and select “Privacy Notice” for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions.

BuSIneSS BACkgRounD InFoRmATIon
 13. Has this business entity ever been known by                   Yes       No
                                                                                     If yes, provide previous name:
     another name?
 14. Has this business entity ever been issued a certificate of registration, certificate number or tax account number by the Florida Department                                                             Yes         No
     of Revenue?
 15. Has any owner/proprietor, partner, officer, member, trustee, or the person whose social security number is provided in items 8c or 12 ever                                                              Yes         No
     been issued a certificate of registration, certificate number or tax account number by the Florida Department of Revenue?
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 16. If you answered “Yes” to questions 14 or                  a.    Name of person or entity named on certificate of registration:
     15, provide the name, address and certificate
                                                               b.    Address of person or entity named on certificate of registration:
     of registration number for each business,
     proprietor, owner, partner, officer, member or            c.    Certificate or tax account number:
     trustee.
 17. To your knowledge, has a tax warrant ever been filed by the Florida Department of Revenue against this business entity?
                                                                                                                                                                         Yes       No

 18. To your knowledge, has a tax warrant ever been filed by the Florida Department of Revenue against any owner/proprietor, partner, officer, member,
                                                                                                                                                                         Yes       No
     trustee, or the person whose social security number is provided in items 8c or 12?
BuSIneSS ACTIvITIeS DeSCRIPTIon
 19a. Describe the primary nature of your business and list all activities,
      products, and services. Include all of your taxable activities if known.
 19b. If known, provide your North American Industry Classification System (NAICS) Code(s). Enter your primary code first. To determine your NAICS code, go
      to www.census.gov/eos/www/naics       Primary Code:




 Section B – Activities Subject to Sales & use Tax                                                        ($5 fee for in-state business/rental locations)
general
20. Does your business (check the yes or no box next to each activity with black or blue pen):
Yes     No
 y      n     a. Sell products or services at retail (to consumers)?
 y      n     b. Sell products or services at wholesale (to registered dealers who will sell to consumers)?
 y      n     c. Purchase or sell secondhand goods (see description in the Sales and Use Tax section of the instructions, Form DR-1N)? If yes, in addition to registering for sales
                 and use tax, complete and submit a Registration Application for Secondhand Dealers and/or Secondary Metals Recyclers (Form DR-1S).
y       n     d. Purchase or sell salvage or scrap metal to be recycled? If yes, in addition to registering for sales and use tax, complete and submit a Registration Application for
                 Secondhand Dealers and/or Secondary Metals Recyclers (Form DR-1S).
y       n     e. Sell products or goods from nonpermanent locations (such as flea markets or craft shows)?
y       n     f. Sell products or goods by mail order using catalogs or the Internet?
y       n     g. Sell prepaid phone cards or calling arrangements?
y       n     h. Rent or lease commercial real property to individuals or businesses?
y       n     i. Rent or lease living or sleeping accommodations to others for periods of six months or less?
                   Does another party manage the property and collect the rent?        Yes       No                   If yes, provide:

               Name:                                                                                                  Telephone number: (       )
               Mailing address:                                                                     City/State/ZIP:
y       n     j. Manage the rental or leasing of living or sleeping accommodations belonging to others?
y       n     k. Rent equipment or other property or goods to individuals or businesses?
y       n     l. Rent or lease motor vehicles to others?
y       n     m. Repair or alter consumer products or equipment?
y       n     n. Charge admission or membership fees?
y       n     o. Place and operate coin-operated amusement machines at business locations belonging to others?
y       n     p. Place and operate food or beverage vending machines at business locations belonging to others?
y       n     q. Place and operate nonfood or nonbeverage vending machines at business locations belonging to others?
y       n     r. Operate vending machines at your business location(s)?
y       n     s. Purchase items that you will include in a finished product assembled or manufactured for sale?
y       n     t. Purchase items for use in your business that were not taxed by the seller when purchased (includes purchases through catalogs, the Internet, or from out-of-state
                 vendors)?
y       n     u. Use dyed diesel fuel for off-road purposes?
y       n     v. Provide any of the following services? If yes, check the box next to each service you provide.
                              (1) Pest control services for nonresidential buildings                              (4) Protection services
                              (2) Interior cleaning services for nonresidential buildings                         (5) Security alarm system monitoring services
                              (3) Detective services
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Coin-operated Amusement machines

21. Are coin-operated amusement machines operated at your business location? ...........................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, answer question a. If no, skip to question 22.

           a.     Do you have a written agreement designating a party other than the applicant entity as the operator of the amusement machines at your location? .......................
                                                                                                                                                                                                                                                                   y    n
                  If yes, provide name, address, and telephone number of machine operator: If no, also complete an Application for Amusement Machine Certificate (Form DR-18).

                    Name:                                                                                                                                                Telephone number: (                      )
                    Mailing address:                                                                                                                              City/State/ZIP:

Real Property Contractors

22. Do you improve real property as a contractor?..............................................................................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, answer questions a–d. If no, skip to question 23.
           a.     Indicate your industry category(s) (check all that apply):                                  residential                commercial                   industrial                utility               bridge/road

           b.     Do you sell products at retail?...............................................................................................................................................................................................................
                                                                                                                                                                                                                                                                   y    n
           c.     Do you purchase materials/supplies from out-of-state vendors for use in your Florida projects? .......................................................................................................
                                                                                                                                                                                                                                                                   y    n
           d.     Do you construct or assemble building components away from your project sites? ............................................................................................................................
                                                                                                                                                                                                                                                                   y    n
motor Fuel Sales

23. Do you sell gasoline, diesel fuel, or aviation fuel at posted retail prices? .....................................................................................................................
                                                                                                                                                                                                                                                                   y    n
       If yes, complete item a. If no, skip to question 24.
      a.        Check the box next to the description that best describes your fuel sales activities.
                     Gas station only                  Gas station/convenience store                         Truck stop                Marine fueling                 Aircraft fueling


  Section C – Activities Subject to Solid waste Fees & Surcharge                                                                                    ($30 dry-cleaning fee applies)
24.        Do you sell tires or batteries, or rent or lease motor vehicles to others? ......................................................................................................................
                                                                                                                                                                                                             y n
           If yes, answer questions a–c. If no, skip to question 25.

           a.     Do you sell (at retail) new tires for motorized vehicles that are sold separately or as part of a vehicle? .............................................................................................
                                                                                                                                                                                                                                                                   y    n
           b.     Do you sell (at retail) new or remanufactured lead-acid batteries that are sold separately or as a component part of another product
                  such as new automobiles, golf carts, boats, etc.? ..................................................................................................................................................................................
                                                                                                                                                                                                                                                                   y    n
           c.     Do you rent or lease motor vehicles that transport fewer than nine passengers to individuals or businesses? ....................................................................................
                                                                                                                                                                                                                                                                   y    n
25. Do you own or operate a dry-cleaning plant or dry drop-off facility in Florida? .......................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, enclose the $30 dry-cleaning registration fee. If no, continue to question 26.

26. Do you produce or import perchloroethylene? ...............................................................................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, also complete a Florida Pollutant Tax Application (Form DR-166). If no, continue to question 27.

  Section D - Activities Subject to unemployment Tax                                                                                                                                                                                                         (no fee)

27. Have you employed or will you employ workers in the state of Florida? ** ...............................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, answer questions 28 and 29.
    If no, skip Section D (questions 28-39).
** Officers performing services for the corporation and receiving payment for such services (salary or distributions) are considered employees of the
   corporation for purposes of unemployment compensation tax.

28. Are you reactivating your unemployment tax (UT) account? .......................................................................................................................................
                                                                                                                                                                                                                                                                   y    n
    If yes, provide your UT Account Number and answer questions 29-39.                                                 UT Account Number
    If no, answer questions 30-39.
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29. Is your business already registered and actively paying Florida unemployment tax? ...............................................................................................
                                                                                                                                                                                                                y    n
    If yes, provide your UT Account Number and skip questions 30-39.                                    UT Account Number
    If no, answer questions 30-39.
30. Employment type (check all that apply):
               Regular employer (employee leasing companies must                                 Nonprofit organization (attach a copy of your 501(c)(3)                          Agricultural crew chief
               attach a copy of their license issued by the Department                           determination letter from the IRS)
               of Business & Professional Regulation [DBPR])                                     Agricultural (noncitrus) employer                                                Governmental entity

               Domestic employer (household & personal care)                                     Agricultural (citrus) employer                                                   Indian tribe or Tribal unit


31. On what date did you, or will you first employ workers in Florida? **.............................................................................

32. Have you or will you pay gross wages of at least $1,500 within a calendar quarter? **....................................................................................................
                                                                                                                                                                                                                y    n
      If yes, provide the date you reached or will reach $1,500 gross wages: ............................................................................

33. Have you or will you employ one or more workers for 20 or more weeks within a calendar year? ** .............................................................................
                                                                                                                                                                                                                y    n
      If yes, provide the date of the 20th week: ..........................................................................................................................

34. Have you paid federal unemployment tax in another state this year or last year? ..............................................................................................................
                                                                                                                                                                                                                y    n
      If yes, in which state: ________________________________________ in which year:.....................................................................................
35. Do you use the services of persons in Florida whom you consider to be self-employed, independent contractors?                                                                                               y    n
    If yes, also complete an Independent Contractor Analysis (UCS-6061). ...........................................................................................................................

36. Do you lease workers from an employee leasing company? ..............................................................................................................................................
                                                                                                                                                                                                                y    n
    If yes, complete items a–f about the leasing company and your leasing arrangement.
       a. Leasing company’s name:

       b. FEIN:                                                            c. DBPR License Number:                                                                d. UT Account Number:



       e. Portion of workforce that is leased:             All          Part                                                      f. Date of leasing arrangement:

37. List the locations where you employ workers in Florida.
       Address:                                                                             City:                                          County:                               Number of employees:

       Principal products or services:
                                                                                            If services, indicate if      Administrative      Research              Other: ________________________________________
       Address:                                                                             City:                                       County:                                 Number of employees:

       Principal products or services:
                                                                                            If services, indicate if      Administrative      Research              Other: ________________________________________
       Address:                                                                             City:                                       County:                                 Number of employees:

       Principal products or services:
                                                                                            If services, indicate if      Administrative          Research          Other: ________________________________________


38. If another party (accountant, bookkeeper, agent) will maintain your payroll and will file reports and/or remit unemployment tax on your behalf, provide the
    following information about the other party:
       Agent name:                                                                                                                                                      Agent number:

       Firm name:                                                                                                                                                       Federal ID number (EIN, PTIN):

       Mailing address:                                                                                            City/State/ZIP:

       E-mail address:


       Capacity of agent:          Filing only          Paying only            Filing & paying
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39. Mailing addresses for unemployment tax – All correspondence about your unemployment tax account, returns, statements, rate notices, and claims and benefits
    information, will be mailed to the address you provided in item 6. If you wish to have these documents mailed elsewhere, provide other addresses below.
      a.     Reporting – Mail Employer’s Quarterly Reports, certifications, and
             correspondence related to reporting to (check one):                                   Employer’s primary address              Agent’s address ( item 38)            Other, below
       Name:                                                                                                                                Telephone number:   (            )
       Mailing address:                                                                                        City/State/ZIP:

       E-mail address:


      b.     Tax Rate – Mail tax rate notices and rate-related correspondence to
             (check one):                                                                          Employer’s primary address              Agent’s address (item 38)             Other, below
       Name:                                                                                                                                Telephone number:   (            )
       Mailing address:                                                                                        City/State/ZIP:

       E-mail address:


      c.     Claims – Mail notices of benefits paid and other correspondence
             about claims and benefits to (check one):                                             Employer’s primary address              Agent’s address (item 38)             Other, below
       Name:                                                                                                                                Telephone number:   (            )
       Mailing address:                                                                                        City/State/ZIP:

       E-mail address:



  Section e - Activities Subject to Communications Services Tax                                                                                                                                (no fee)

40. Do you sell communications services or purchase communications services to integrate into prepaid calling arrangements? .............................
                                                                                                                                                                                                      y    n
    If yes, check the box next to each service you sell, and answer questions 41-44. If no, skip Section E (questions 41-44).
             Telephone service (local, long distance or wireless)                                                                Cable service
             Paging service                                                                                                      Direct-to-home satellite service
             Facsimile (fax) service (not in the course of advertising or professional services)                                 Pay telephone service
             Reseller (only sales for resale; no sales to retail customers)                                                      Purchase services to integrate into prepaid calling arrangements
             Other services; please describe: _______________________________________________________________________________________________________________

41. Are you applying for a direct pay permit for communications services tax?......................................................................................................................
                                                                                                                                                                                                      y    n
    If yes, also complete an Application for Self-Accrual Authority/Direct Pay Permit (Form DR-700030).
42. In order to charge the correct amount of tax, you must know the taxing jurisdiction in which your customers are located. How will you verify the correct
    assignment of customer location to taxing jurisdiction? If you use multiple databases, check all that apply. If you sell only pay telephone or direct-to-home
    satellite services, provide prepaid calling arrangements, are a reseller, or are applying for a direct pay permit, skip to item 44.
               1. An electronic database provided by the Department.
               2. Your own database that will be certified by the Department; to apply for certification, you must complete an Application for Certification of Communications Services
                  Database (Form DR-700012).
               3. A database supplied by a vendor. Provide the vendor’s name: ___________________________________________________________________________________
               4. ZIP+4 and a methodology for assignment when ZIP codes overlap jurisdictions.
               5. ZIP+4 that does not overlap jurisdictions (i.e., a hotel located in one jurisdiction).
               6. None of the above.

43. If you wish to be eligible for both collection allowances, check the box below. See instructions for explanation.
            I will file two separate communications services tax returns in order to maximize my collection allowance.
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44. Name and contact information of the managerial representative who can answer questions about filed tax returns:
       Name:                                                                                                                                             Telephone number:      (            )
       Mailing address:                                                                                                  City/State/ZIP:

       E-mail address:


  Section F - Activities Subject to Documentary Stamp Tax                                                                                                                                                        (no fee)
45. Do you make sales, finalized by written financing agreements, that are not recorded by the Clerk of the Court,
    but do require documentary stamp tax to be paid? .......................................................................................................................................................
                                                                                                                                                                                                                        y   n
    If yes, complete items a-b. If no, skip to question 46.

       a.     Do you anticipate five or more transactions subject to documentary stamp tax per month? ...............................................................................................................
                                                                                                                                                                                                                        y   n
       b.     In addition to the location provided for item 5, list all other locations where books and records are kept.
       Address:                                                                                                     City/State/ZIP:


       Address:                                                                                                     City/State/ZIP:


       Address:                                                                                                     City/State/ZIP:


       Address:                                                                                                     City/State/ZIP:



  Section g - Activities Subject to gross Receipts Tax on electrical Power and gas                                                                                                                               (no fee)

46. Do you own or operate a local electric or natural or manufactured gas (excluding LP gas) utility distribution facility in Florida? ....................
                                                                                                                                                                                                                        y    n
    If yes, check the items below that apply and answer question b. If no, skip to question 47.
       a.            Electricity         Natural or manufactured gas

       b.     Do you import into Florida natural or manufactured gas (excluding LP gas) for your own use instead of purchasing taxable utility or transportation services?.....
                                                                                                                                                                                                                        y    n

  Section h - Activities Subject to Severance Taxes & miami-Dade County Lake Belt Fees                                                                                                                           (no fee)

47. Do you extract oil, gas, sulfur, solid minerals, phosphate rock or heavy minerals from the soils or waters of Florida?.........................................
                                                                                                                                                                                                                        y    n
    If yes, check the box next to each activity you are engaged in. If no, skip to question 48.
                a.      Extracting oil for sale, transport, storage, profit, or commercial use.
                b.      Extracting gas for sale, transport, profit, or commercial use.
                c.      Extracting sulfur for sale, transport, storage, profit, or commercial use.
                d.      Extracting solid minerals, phosphate rock, or heavy minerals from the soil or water for commercial use.
                e.      Extracting lime rock or sand from within the Miami-Dade County Lake Belt Area (see s. 373.4149, F.S., for boundary description).

  Section I – enrollment to File and Pay Taxes and Fees electronically                                                                                                                                           (no fee)
For detailed information about the e-Services program, see the instructions (Form DR-1N) or go to www.myflorida.com/dor and select Enroll for tax e-Services.

48. Do you wish to enroll to file and pay taxes, fees, and surcharges electronically? ........................................................................................................
                                                                                                                                                                                                                        y    n
    If yes, provide the following information to enroll in the e-Services program. If no, skip Section I (questions 49-53).
49. Contact Person for Electronic Payments
       Name:                                                                                                Telephone number:                                          Fax number:
                                                                                                            (     )                                                    (     )
       Mailing address:                                                                                     City/State/ZIP:

       E-mail address:

                                                                                                                                          Federal PTIN (if tax preparer):
              a company employee                  a non related tax preparer                the UT Agent named in item 38
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50. Contact Person for Electronic Return Filing                 Check if same as contact person for electronic payments.
     Name:                                                                                  Telephone number:                               Fax number:
                                                                                            (     )                                         (     )
     Mailing address:                                                                       City/State/ZIP:

     E-mail address:

                                                                                                                   Federal PTIN (if tax preparer):
            a company employee             a non related tax preparer        the UT Agent named in item 38

51. Choose your filing/payment method:
      Tax(es) for which You are Registering                                             Internet File/Pay          Software File/Pay            EFT Pay Only           Direct File/Pay
      Sales and use tax
      Solid waste fees and surcharge
      Unemployment tax
      Communications services tax
      Documentary stamp tax
      Gross receipts tax
      Severance taxes
      Miami-Dade County Lake Belt Fees
      Corporate income tax (F-1120A, short form)
      Corporate income tax (F-1120, long form)
          Check if you wish to use the ACH-Credit payment method. This is not the use of a credit card to make your payment. To use this payment method, you must transfer
          the payment from your bank account to the State’s bank account. Approval is required.

52. Banking Information (not required for ACH-Credit)
      a.     Bank/financial institution name:                                                     b.    Bank account number:

      c.     Address of branch location:                                                          d.    ABA Routing/Transit Number:
                                                                                                                                       |:                                                :|

      e.     Account type:              Business checking               Personal checking              Business savings          Personal savings


53 Enrollee Authorization and Agreement
           This is an Agreement between the Florida Department of Revenue, hereinafter “the Department,” and the business entity named herein, hereinafter “the Enrollee,” entered
           into according to the provisions of the Florida Statutes and the Florida Administrative Code.
           By completing this agreement and submitting this enrollment request, the Enrollee applies and is hereby authorized by the Department to file tax returns and reports,
           make tax and fee payments, and transmit remittances to the Department electronically. This agreement represents the entire understanding of the parties in relation to the
           electronic filing of returns, reports, and remittances.
           The same statute and rule provisions that pertain to all paper documents filed or payments made by the Enrollee also govern an electronic return, or payment initiated
           electronically according to this agreement.
           I certify that I am authorized to sign on behalf of the business entity identified herein, and that all information provided in this document has been personally reviewed by
           me and the facts stated in it are true. According to the payment method selected above, I hereby authorize the Department to present debit entries into the bank account
           referenced above at the depository designated herein (ACH-Debit), or I am authorized to register for the ACH-Credit payment privilege and accept all responsibility for the
           filing of payments through the ACH-Credit method.

           Signature: _______________________________________________________                    Title: ____________________________________              Date: ______________________


           Printed name: _______________________________________________________________________________________________


           Second Signature: ________________________________________________                    Title: ____________________________________              Date: ______________________
           (If dual account)

           Printed name: _______________________________________________________________________________________________
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Section J - Applicant Acknowledgement, Declaration and Signature
 Registrant’s Responsibilities – You must initial next to each responsibility listed below to indicate that you have read, acknowledge, and understand each one. Your application
 will be rejected if any part of this section is left blank.
       ______      I understand it is my responsibility to timely notify the Department of Revenue of any changes of business structure, activities, location, mailing address or
                   contact information.
       ______      I understand that any person (including but not limited to: owners, employees, partners, managing members, corporate officers, etc.) who is required to collect,
                   truthfully account for, and pay any tax, surcharge or fee, and willfully fails to do so shall be personally liable for penalties under the provisions of s. 213.29, F.S.
 In addition to any other penalties provided by law, including civil penalties, I understand it is a criminal offense to:
       ______      Fail or refuse to register (a late registration fee or penalty may also be imposed).
       ______      Not timely file a tax return or report.
       ______      Underreport a tax, surcharge or fee liability on a return or report filed.
       ______      Fail or refuse to collect a required tax, surcharge or fee.
       ______      Not remit a collected tax, surcharge or fee.
       ______      Make a worthless check, draft, debit card payment, or electronic funds transfer to the Department.
 Authorized Signature – Depending on your business structure, only the following principal persons may sign this application:
       •     If the applicant is a sole proprietor, the individual owner must sign.
       •     If the applicant is a partnership, a general partner must sign.
       •     If the applicant is a corporation, an incorporator or officer must sign.
       •     If the applicant is a limited liability company, a member or manager (if authorized by the members) must sign.
       •     If the applicant is a trust, the grantor or a trustee must sign.
       •     If the applicant is an estate, the personal representative, executor or executrix must sign.
       •     If the applicant is a government agency, Indian tribe or tribal unit, an official authorized to sign on behalf of the agency, tribe or tribal unit must sign.
 Note: The person signing the application must be listed under item 12 in the Business Structure & Ownership section.
 Applicant Attestation, Declaration, and Signature
       Under penalties of perjury, I attest that I am the applicant, or that I am an authorized principal of the applicant entity identified herein, and also declare that I have
       read the information provided on this application and that the facts stated in it are true.

 Signature: __________________________________________________________________________________                                      Title: _______________________________________

 Printed name: _______________________________________________________________________________                                      Date: _______________________________________

 Amount enclosed: $ ____________              •   $ 5 fee – Sales tax registration for business or rental property located in Florida
                                              •   $30 fee – Solid waste fee & surcharge registration for dry cleaners


              uSe ThIS CheCkLIST To enSuRe FAST PRoCeSSIng oF youR APPLICATIon.
✓ Complete all required sections of this application.                                           ✓ Mail to: Account management - mail Stop 1-5611
✓ Make sure that you have provided your FEIN or SSN.                                                        Florida Department of Revenue
✓ Sign and date the application.                                                                            5050 w Tennessee St
                                                                                                            Tallahassee FL 32399-0160
✓ Attach check or money order for appropriate registration
  fee(s). DO NOT SEND CASH.                                                                       You may also mail or deliver your application to any
                                                                                                  Department of Revenue service center. Addresses
✓ Attach required documentation or additional applications, if                                    and telephone numbers are posted on our website
  applicable.                                                                                     (www.myflorida.com/dor) and included in the instructions
                                                                                                  for this application (Form DR-1N).

                                                                                 FoR DoR uSe onLy

Pm/Delivery                                                                  Contract object (mo)
                                                                                                                            -                                                       -
B.P. no.                                                                     Certificate no.

uT Acct. no.                                                                 Contract object (other)

nAICS Code(s):
       Account management - mail Stop 1-5611
                                                         Affix
       Florida Department of Revenue                    Postage
       5050 w Tennessee St
       Tallahassee FL 32399-0160




                     Did You Know?
you can register online. It’s free, easy to use, and secure.
               go to www.myflorida.com/dor
Questions?
If you have questions regarding a specific license or permit application, please contact the licensing authority
using the contact information provided on the application coversheet preceding the specific application.

Have questions about the content of this package? Please contact us using the contact information provided
below. Please note: questions that are of a nature that require additional research not covered in this report
will be subject to additional charges.


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  Call: (888) 752-4111
Email: support@license123.com


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