Form Dr-1con - Application For Consolidated Sales And Use Tax Filing Number - 2011 Page 2
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9.
Are you currently or should you be obligated for one or more of the following tax liabilities:
Vending
Amusement
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Retail Food/Beverage
Wholesale Food/Beverage
Retail other
Tire
Battery
Dry-Cleaning
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Retail Fuel Sales
Marina
Off-Road Diesel
10.
Month of first consolidated filing (effective date is the first of the month; allow four weeks for processing): _________________
11.
List the complete Sales and Use Tax Number (as shown on your certificate, Form DR-11) for each business location you wish
to report under this consolidated number. Attach additional sheets, if necessary.
12.
Applicant Signature —This Application Cannot Be Processed If Not Signed by the Applicant.
Under penalties of perjury, I declare that I have read the information provided in this application and the facts stated in it are true.
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Signature of Business Owner, Principal Partner, or Corporate Officer
Date Application Signed
________________________________________________________________
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Print or Type the Name Signed Above
Title of Signatory
Mail this completed application to:
Florida Department of Revenue
Account Management
PO Box 6480
Tallahassee, FL 32314-6480
Or, FAX to: 850-922-5938
There is no fee required for registering to file a consolidated return.
FOR DOR OFFICE USE ONLY
BP____________
CA____________
CO____________
SIC
Kind Code
Consolidated Number
Number of Locations
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Parent category: Financial