Dr 15-0 Oyster Surcharge Return Form - Apalachicola Bay Page 2

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For Information and Forms
Information and forms are available on our Internet
Need Assistance?
site at
To speak with a Department of Revenue
representative, call Taxpayer Services, Monday
through Friday, 8 a.m. to 7 p.m., ET, at
1-800-352-3671 (in Florida only) or 850-488-6800.
Need Forms?
For a written response to your questions, write:
To receive forms by mail:
TAXPAYER SERVICES
• Order multiple copies of forms from our Internet
FLORIDA DEPARTMENT OF REVENUE
site at /forms or
1379 BLOUNTSTOWN HWY
• Fax your form request to the DOR Distribution
TALLAHASSEE FL 32304-2716
Center at 850-922-2208 or
• Call the DOR Distribution Center at
Hearing or speech impaired persons may call the
850-488-8422 or
TDD line at 1-800-367-8331 or 850-922-1115.
• Mail your form request to:
DISTRIBUTION CENTER
Department of Revenue service centers host
FLORIDA DEPARTMENT OF REVENUE
educational seminars about Florida’s taxes. For a
168A BLOUNTSTOWN HWY
schedule of upcoming seminars,
TALLAHASSEE FL 32304-3702
• Visit us online at or
• Call the service center nearest you.
To receive a fax copy of a form, call 850-922-3676
from your fax machine telephone and follow the
voice prompts.
I HEREBY CERTIFY THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE AND COMPLETE RETURN.
AUTHORIZED WHOLESALE
TITLE
DATE
PHONE NUMBER
Change of ownership
Change of Address
if discontinued
FEI/SSN __________________________________________
Temporarily
Dates: from ___________ to ___________
Business name ____________________________________
Permanently
Date: ______________________________
Mailing address ____________________________________
If sold, to whom:
Name _____________________________________________
City , State , ZIP____________________________________
Address ___________________________________________
_________________________________________________
City , State, ZIP _____________________________________
__________________________________________________

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