Form Ez-M - Florida Enterprise Zone Program Page 3
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5Is the business a small business as defined by s. 288.703(1), F.S.? ____ yes _____ no
Please note: This question is for statistical purposes and does not impact the sales tax refund request.
REQUESTING A SALES TAX REFUND IN EXCESS OF $5,000.00
This section is to be completed if the business is applying for a sales tax refund exceeding $5,000.00.
If applying for a sales tax refund in excess of $5,000.00, please complete Schedules A and B that are attached.
The attachments must include the signature of the taxpayer as well as the Enterprise Zone Coordinator who
certified the Enterprise Zone location of the applicant.
S
A: T
N
P
, F
-T
E
(E
Z
R
)
CHEDULE
OTAL
UMBER OF
ERMANENT
ULL
IME
MPLOYEES
NTERPRISE
ONE
ESIDENTS
S
B: P
, F
-T
E
(N
-E
Z
R
)
CHEDULE
ERMANENT
ULL
IME
MPLOYEES
ON
NTERPRISE
ONE
ESIDENTS
CALCULATION OF PERCENTAGE OF EMPLOYEES:
1.
Total number of employees from Schedule A:
_________________
2.
Total number of employees from Schedules A and B:
_________________
3.
Percentage of permanent, full-time employees residing
in enterprise zones (divide Line 1 by Line 2, enter result):
_________________
MAXIMUM AMOUNT OF SALES TAX REFUND
If Line 3 is less than 20%, the maximum amount of tax refund is $5,000.
If Line 3 is 20% or greater, the maximum amount of tax refund is $10,000.
TAXPAYER SIGNATURE
I hereby certify that I have examined statements contained on this form, and to the best of my knowledge and
belief they are true, correct and complete.
________________________________________________
S
T
D
IGNATURE OF
AXPAYER
ATE
________________________________________________
S
E
Z
C
D
IGNATURE OF
NTERPRISE
ONE
OORDINATOR
ATE
________________________________________________
P
N
EZDA
F
N
EZDA
HONE
UMBER OF
AX
UMBER OF
Original forms must reach the Florida Department of Revenue within:
6 months of the date of certificate that the improvements are substantially completed or
by November 1st after the rehabilitated property is first subject to assessment for the
improvements.
Taxpayer is required to send:
a completed Form EZ-M (with required attachments) along with
a completed Form DR-26S: Application for Tax Refund to:
Florida Department of Revenue
Refunds Sub-Process
Post Office Box 6490
Tallahassee, Florida 32314-6490
850/488-8937
EZDA retains one copy of this form for EZDA files
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