Form Dr-1c - Application For Collective Registration For Short-Term Rental Of Living Or Sleeping Accommodations - Department Of Revenue, State Of Florida Page 2

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DR-1C
R. 05/12
Application for Collective Registration for
Rental of Short-term Living or Sleeping
(Copy this page for additional sheets ) Page _____
Accommodations
Name of Agent, Representative or Management Company
Agent ’ s Certificate Number for this County
County Name
Individual Property Location Information
Check this box if this property is a time-share unit.
Name of Property Owner (or time-share unit number/designation)
Property Owner ’ s SSN, FEIN or ITIN*
Beginning Date of Management Agreement
Type of Ownership
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Business Trust
Non-Business Trust
Estate
Street Address of Property
City
County
ZIP Code
Property Owner ’ s Mailing Address
City
State
ZIP Code
Owner's Telephone Number
If owner has a sales and use tax certificate number, provide it here **
DOR USE ONLY
Individual Property Location Information
Check this box if this property is a time-share unit.
Name of Property Owner (or time-share unit number/designation)
Property Owner ’ s SSN, FEIN or ITIN*
Beginning Date of Management Agreement
Type of Ownership
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Business Trust
Non-Business Trust
Estate
Street Address of Property
City
County
ZIP Code
Property Owner ’ s Mailing Address
City
State
ZIP Code
Owner's Telephone Number
If owner has a sales and use tax certificate number, provide it here **
DOR USE ONLY
Individual Property Location Information
Check this box if this property is a time-share unit.
Name of Property Owner (or time-share unit number/designation)
Property Owner ’ s SSN, FEIN or ITIN*
Beginning Date of Management Agreement
Type of Ownership
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Business Trust
Non-Business Trust
Estate
Street Address of Property
City
County
ZIP Code
Property Owner ’ s Mailing Address
City
State
ZIP Code
Owner's Telephone Number
If owner has a sales and use tax certificate number, provide it here **
DOR USE ONLY
Individual Property Location Information
Check this box if this property is a time-share unit.
Name of Property Owner (or time-share unit number/designation)
Property Owner ’ s SSN, FEIN or ITIN*
Beginning Date of Management Agreement
Type of Ownership
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Business Trust
Non-Business Trust
Estate
Street Address of Property
City
County
ZIP Code
Property Owner ’ s Mailing Address
City
State
ZIP Code
Owner's Telephone Number
If owner has a sales and use tax certificate number, provide it here **
DOR USE ONLY

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