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

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

DR-842

R.03/00

General Tax Administration

Child Support Enforcement

Seller’s Application for Transferee Liability

Property Tax Administration

Administrative Services

Certificate

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

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