Dr-654 Request For Waiver From Electronic Filing Form
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1DR-654
REQUEST FOR WAIVER FROM ELECTRONIC FILING
R. 12/01
Business Partner or
Tax Account Number: _______________________________________
FEIN or SSN: ______________________________
Business Name: ___________________________________________
Phone Number: ____________________________
Contact Person: ___________________________________________
Fax Number: ______________________________
Contact Address: ____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
The questions below are to assist you in determining your electronic filing capability.
1.
Does your business or company currently file information or data electronically with other businesses or government agencies?
[
] yes
[
] no
2.
Does your business or company have an IBM or IBM-compatible computer (PC) with DOS 3.1 or Windows 3.1 or higher?
[
] yes
[
] no
A.
Does your business or company have access to equipment with a minimum of 512K RAM?
[
] yes
[
] no
B.
Does your business or company have access to equipment with a minimum 1 MB available hard disk space?
[
] yes
[
] no
C.
Does your business or company have a modem (minimum 2400 baud)?
[
] yes
[
] no
3.
Does your business or company have access to the Internet?
[
] yes
[
] no
If you answered “no” to question 1, any part of question 2, and question 3, you may meet the criteria for a waiver from electronic
filing. The Department of Revenue recognizes that certain conditions may preclude your business from purchasing the
necessary equipment to file electronically and does not require the purchase of computer equipment. All approved waivers
must be renewed upon expiration, even if there is no change in your reporting capability. If there is a change in your reporting capability
as stated above, you must begin filing electronically or submit a revised Request for Waiver from Electronic Filing .
If you answered “yes” to question 1, all of question 2, or question 3, you are capable of electronic filing. If there are additional
reasons for requesting a waiver from the requirement, you must provide a written explanation on the back of this form.
Your request will be evaluated and a written response will be mailed to you. Remember, you are required to remit payments by
Electronic Funds Transfer (EFT) even if a waiver from electronic filing is granted.
I certify that the above information is true and accurate.
_________________________________________
________________________________
________________________
Name (please print)
Signature
Date
_________________________________________
Title
Mail your completed Form DR-654 to :
e-Services Unit
Florida Department of Revenue
PO Box 5885
Tallahassee FL 32314-5885
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