Form Dr-18 - Application For Amusement Machine Certificate - 2001 Page 2
ADVERTISEMENT
1
2
3DR-18
R. 06/01
Page 2
Florida Department of Revenue
LINE-BY-LINE INSTRUCTIONS
Service Centers
1.
Sales and use tax registration number: Enter the sales tax
number of the "operator." Refer to the reverse side to
Alachua Service Center
Marianna Service Center
determine who is the "operator." If you do not have a sales
14107 US Highway 441 Ste 100
4230 Lafayette St Ste D
tax number, you must first obtain one by completing the
Alachua FL 32615-6378
Marianna FL 32446-8234
Application to Collect and/or Report Tax in Florida (Form
386-418-4444 (ET)
850-482-9518 (CT)
DR-1). Consolidated sales tax filers will place their
Clearwater Service Center
Miami Service Center
consolidated number here. Enter this number at the top of
Arbor Shoreline Office Park
8175 NW 12th St Ste 119
page 2, also.
19337 US Highway 19 N Ste 200
Miami FL 33126-1831
Clearwater FL 33764-3149
305-470-5001 (ET)
2.
Name of operator: Enter name of operator. If the operator is
727-538-7400 (ET)
a corporation, enter corporate name. Enter this name also at
Naples Service Center
the top of page 2.
Cocoa Service Center
The Wilson Professional Center
2428 Clearlake Rd Bldg M
3200 Bailey Ln Ste 150
3.
Business name of operator: Enter the name of the business
Cocoa FL 32922-5710
Naples FL 34105-8506
determined to be the operator.
321-504-0950 (ET)
941-436-1050 (ET)
4.
Operator's mailing address: Enter the mailing address of
Coral Springs Service Center
Orlando Service Center
the operator. Certificates and renewal notices will be mailed to
Florida Sunrise Tower
Orlando Executive Center
this address only.
3111 N University Dr Ste 501
5420 Diplomat Cir
Coral Springs FL 33065-5096
Orlando FL 32810-5607
5.
Daytime telephone number: Enter the area code and
954-346-3000 (ET)
407-623-1141 (ET)
telephone number of the person to be contacted if the
Department has questions regarding this completed
Daytona Beach Service Center
Panama City Service Center
1821 Business Park Blvd
703 W 15th St Ste A
application.
Daytona Beach FL 32114-1230
Panama City FL 32401-2238
6.
Certification by operator or operator's authorized
386-274-6600 (ET)
850-872-4165 (CT)
representative: Read carefully and sign. This application will
Fort Myers Service Center
Pensacola Service Center
be returned if not signed by the operator or the operator's
2295 Victoria Ave Ste 270
3670C N L St
authorized representative.
Fort Myers FL 33901-3871
Pensacola FL 32505-5217
941-338-2400 (ET)
850-595-5170 (CT)
7-9.
Complete separate section for each location where
machines are operated.
Hollywood Service Center
Port Richey Service Center
Taft Office Complex
6709 Ridge Rd Ste 300
Location business name: If business name where
6565 Taft St Ste 300
Port Richey FL 34668-6842
machine(s) is (are) located is different from No. 3 above,
Hollywood FL 33024-4044
727-841-4407 (ET)
provide the complete name.
954-967-1000 (ET)
Port Saint Lucie Service Center
Physical Address: Enter the complete address where the
Jacksonville Service Center
900 E Prima Vista Blvd Ste 300
machine(s) is (are) located (DO NOT USE A POST OFFICE
921 N Davis St A250
Port Saint Lucie FL 34952-2363
BOX).
Jacksonville FL 32209-6829
561-871-7620 (ET)
904-359-6070 (ET)
Sales tax number for this location: Enter the machine
Sarasota Service Center
operator's sales tax number for this location. If you operate
Key West Service Center
Sarasota Main Plaza
machines in multiple locations, provide your sales tax number
3118 Flagler Ave
1991 Main St Ste 240
Key West FL 33040-4698
Sarasota FL 34236-5934
used within the county of this location.
305-292-6725 (ET)
941-361-6001 (ET)
Maximum number of machines: Enter the actual number of
Lake City Service Center
Tallahassee Service Center
machines operated/to be operated at this location. You may
2651 W US Highway 90
2410 Allen Rd
not place more machines at a location than are shown on the
Lake City FL 32055-3173
Tallahassee FL 32312-2603
certificate.
386-758-0420 (ET)
850-488-9719 (ET)
Check one: If you are applying for the first certificate for this
Lakeland Service Center
Tampa Service Center
location, check "new location." Enter the number of machines
230 S Florida Ave Ste 101
Ste 100
and multiply by $30. This is the fee amount that is due for this
Lakeland FL 33801-4625
6302 E Martin Luther King Blvd
location. If you are adding machines to a previously issued
863-499-2260 (ET)
Tampa FL 33619-1166
certificate, check "update" and give amusement machine
813-744-6344 (ET)
Leesburg Service Center
certificate number. Enter the number of additional machines
734 N 3rd St Ste 117
West Palm Beach Service Center
and multiply by $30. This is the fee amount that is due for this
Leesburg FL 34748-4498
2468 Metrocentre Blvd
location.
352-360-6660 (ET)
West Palm Beach FL 33407-3199
561-640-2800 (ET)
10.
Summary of fee(s) paid: Add all new machines on this
application and enter total here. Multiply total by $30. Enter
CT—Central Time
this dollar amount. This is the total fee due with this
ET—Eastern Time
application. Make checks payable to Florida Department of
Revenue.
*DO NOT SEND CASH*
For further assistance, contact Central Registration at
850-488-9750 or the nearest service center.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial