Form 1120es - Corporate Income Tax - 2004

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Florida Department of Revenue — Corporate Income Tax
F-1120ES
R. 01/04
Declaration/Installment of Florida Estimated Income/Franchise and/or
Installment
#_____
Emergency Excise Tax for Taxable Year Beginning on or After January 1, 2004
0 1 2 3 4 5 6 7 8 9
0123456789
You must write within the boxes.
If typing, type through the boxes.
(example)
(example)
Write your numbers as shown and enter one number per box.
FEIN
F-1120ES
Taxable
Y
M
M
D
D Y
year end
Name
Estimated tax payment
Address
City/St/ZIP
(See reverse side)
US DOLLARS
CENTS
Check here if you transmitted
Office use
M
M
D
D Y
Y
funds electronically
only
Make checks payable and mail to:
FLORIDA DEPARTMENT OF REVENUE
5050 W TENNESSEE ST
TALLAHASSEE FL 32399-0135
9999090999999990000200503300039999999990000002

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