Form Dr-654 - Request For Waiver From Electronic Filing

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DR-654
Request for Waiver from Electronic Filing
R. 11/05
You must be enrolled to pay tax electronically.
See “Electronic Payment Required” box below.
Business partner or
Tax account number: _______________________________________
Type of tax: _______________________________
Business name: ____________________________________________
FEIN or SSN: ______________________________
Contact person: ____________________________________________
Phone number: ____________________________
Contact address: ___________________________________________
Fax number: _______________________________
___________________________________________
E-mail address: ____________________________
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 or filing software. The questions
below will assist you in determining your electronic filing capability.
1.
Does your business currently file information electronically with other businesses or government agencies?
[
]
yes
[
]
no
2.
Does your business have a computer (PC) with a 486/66-MHz processor or higher that operates Windows 98 or higher, or
Macintosh version 5.1.6?
[
]
yes
[
]
no
3.
Does your business have access to the Internet?
[
]
yes
[
]
no
4.
A waiver may be valid for up to two years, except for consolidated filers. The issuance of a subsequent waiver will be
contingent on the taxpayer working with the Department during the current waiver period to resolve the circumstances that
originally required the issuance of the waiver. Length of waiver period requested: ____________________________________
Note: Consolidated Sales tax filers will only be considered for a one time waiver, not to exceed one year.
5.
Do you use an external programmer, software developer, or service provider for the computation, reporting, and/or payment of
this tax?
[
]
yes
[
]
no
If yes, provide the name of the person or company: ____________________________________________________________
Attach a written explanation if you have additional reasons for requesting a waiver. The Department will verify the information you
provide. Your request will be evaluated and you will receive a written response.
Electronic Payment Required
The requirement for electronic payment of taxes cannot be waived. You are required to pay your tax by Electronic Funds
Transfer (EFT) even if a waiver from electronic filing is granted. If not already enrolled, an “Enrollment and Authorization for
e-Services Program” (Form DR-600) form must be submitted prior to, or must accompany this waiver request. Select either
“EFT only w/ACH-Debit” or “EFT only w/ACH-Credit” as your payment method. Electronic payment can be initiated with a touch-tone
telephone.
I, the undersigned, agree that the Department will return this request to me without processing it if it is incomplete or contains
inaccurate information. I further agree that if I fail to submit to the Department a complete, accurate request at least 10 consecutive
working days before my first electronic tax return is due, I will be required to submit such return electronically for such taxable
period, since the Department will have an insufficient period of time in which to process the waiver request.
_____________________________________________________ ____________________________________________________
Print Name (Must be CEO, CFO, or owner)
Title
_____________________________________________________ ____________________________________________________
Signature
Date
Mail your completed
or fax to:
E-Services Unit
850-922-5088
Form DR-654 to:
Florida Department of Revenue
PO Box 5885
Tallahassee FL 32314-5885

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