Form Dr-842 - Seller'S Application For Transferee Liability Certificate - 2000


General Tax Administration
Child Support Enforcement
Seller’s Application for Transferee Liability
Property Tax Administration
Administrative Services
Information Services
Jim Zingale
Executive Director
The undersigned, having sold or entered into an agreement to sell a business or stock of goods (as evidenced by the
document attached hereto and made a part hereof), hereby applies for a transferee liability certificate on behalf of:
Name of Selling Dealer: ________________________________________________
Mailing Address: ______________________________________________________
City, State, Zip: _______________________________________________________
Sales and Use Tax Registration Number: ___-___-___________-___
FEIN/SSN: ______________________
It is requested that the certificate be based on an audit of the selling dealer’s records of transactions during the period that
began: __________________________ and ended: ______________________________.
It is further requested that the certificate be transmitted to:
Name of Purchaser: __________________________________________
Mailing Address:
City, State, Zip:
Permission is given to include in the certificate information disclosed as a result of the requested audit which could not,
without permission, be disclosed without violating the confidentiality requirements of Section 213.053, Florida Statutes.
Signature of Owner or Representative of Selling Dealer: _____________________________________________
Name of Owner or Representative: ____________________________________________
(Please print)
Telephone Number: ____________________________
If you have questions, or need assistance in completing your application, please call 850-921-8737.
Mail to: General Tax Administration Program
Compliance Support Process
Post Office Box 5139
Tallahassee, Fl 32314-5139
Fax: 850-488-0325
Tallahassee, Florida 32399-0100


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Parent category: Financial