Form F-7004 - Florida Tentative Income / Franchise Tax Return And Application For Extension Of Time To File Return

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Rule 12C-1.051
Florida Department of Revenue - Corporate Income Tax
F-7004
Florida Administrative Code
Effective 01/17
R. 01/17
Florida Tentative Income / Franchise Tax
TC
Return and Application for Extension of Time to File Return
0123456789
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
(example)
(example)
F-7004
Write your numbers as shown and enter one number per box.
FEIN
Name
Taxable year end:
1065
1120S
Type of federal
Address
return to be filed
M
M
D
D Y
Y
(Mark “X” in
City/St
one box only)
All other federal
ZIP
returns to be filed
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
US DOLLARS
CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Tentative tax due
Sign here: __________________________________________Date: _______________
(See reverse side)
Make checks payable to and mail to:
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
9200 0 20169999 0002005030 0 3999999999 0000 2
Rule 12C-1.051
Florida Department of Revenue - Corporate Income Tax
Florida Administrative Code
F-7004
Effective 01/17
R. 01/17
Florida Tentative Income / Franchise Tax
TC
Return and Application for Extension of Time to File Return
0123456789
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
(example)
(example)
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Name
Taxable year end:
1065
1120S
Type of federal
Address
return to be filed
M
M
D
D Y
Y
(Mark “X” in
City/St
one box only)
All other federal
ZIP
returns to be filed
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
US DOLLARS
CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Tentative tax due
Sign here: __________________________________________Date: _______________
(See reverse side)
Make checks payable to and mail to:
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
9200 0 20169999 0002005030 0 3999999999 0000 2
Rule 12C-1.051
Florida Department of Revenue - Corporate Income Tax
F-7004
Florida Administrative Code
Effective 01/17
R. 01/17
Florida Tentative Income / Franchise Tax
TC
Return and Application for Extension of Time to File Return
0123456789
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
(example)
(example)
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Name
Taxable year end:
1065
1120S
Type of federal
Address
return to be filed
M
M
D
D Y
Y
(Mark “X” in
City/St
one box only)
ZIP
All other federal
returns to be filed
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
US DOLLARS
CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Tentative tax due
Sign here: __________________________________________Date: _______________
(See reverse side)
Make checks payable to and mail to:
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
9200 0 20169999 0002005030 0 3999999999 0000 2

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