Form Dr 18 - Application For Amusement Machine Certificate Page 2
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1
2DR-18
R. 02/00
Page 2
LINE-BY-LINE INSTRUCTIONS
*DO NOT SEND CASH*
1.
Sales & Use Tax Registration Number: Enter the sales tax
For further assistance, contact the Registration Section at 850-488-
number of the "operator." Refer to the reverse side to deter-
9750 or the nearest Service Center.
mine who is the "operator." If you do not have a sales tax
number, you must first obtain one by completing the Application
for Sales & Use Tax Registration (Form DR-1). Consolidated
Sales Tax Filers will place their consolidated number here.
Enter this number also at the top of page 2.
Florida Department of Revenue
Service Centers
2.
Name of Operator: Enter name of operator. If owner is a
corporation, enter corporate name. Enter this name also at the
Clearwater Service Center
Marianna Service Center
top of page 2.
Arbor Shoreline Office Park
4230 Lafayette St Ste D
19337 US Highway 19 N Ste 200
Marianna FL 32446-8234
Clearwater FL 33764-3149
850-482-9518 (CT)
3.
Business Name of Operator: Enter the name of the business
727-538-7400 (ET)
determined to be the operator.
Miami Service Center
Cocoa Service Center
8175 NW 12th St Ste 119
4.
Operator's Mailing Address: Enter the mailing address of the
2428 Clearlake Rd Bldg M
Miami FL 33126-1831
operator. Certificates and renewal notices will be mailed to this
Cocoa FL 32922-5710
305-470-5001 (ET)
address only.
407-504-0950 (ET)
Naples Service Center
Coral Springs Service Center
The Wilson Professional Center
5.
Daytime Telephone Number: Enter the area code and tele-
Florida Sunrise Tower
3200 Bailey Ln Ste 150
phone number of the person to be contacted if the Department
3111 N University Dr Ste 500
Naples FL 34105-8506
has questions regarding this completed application.
Coral Springs FL 33065-5096
941-436-1050 (ET)
954-346-3000 (ET)
6.
Certification by Operator or Operator's Authorized Representa-
Orlando Service Center
tive: Read carefully and sign. This application will be returned if
Daytona Beach Service Center
Orlando Executive Center
not signed by the operator or the operator's authorized repre-
1821 Business Park Blvd
5420 Diplomat Cir
Daytona Beach FL 32114-1230
Orlando FL 32810-5607
sentative.
904-274-6600 (ET)
407-623-1141 (ET)
7-10. Complete separate section for each location where machines
Fort Myers Service Center
Panama City Service Center
are operated.
2295 Victoria Ave Ste 270
703 W 15th St
Fort Myers FL 33901-3871
Panama City FL 32401-2238
Location Business Name: If business name where machine(s)
941-338-2400 (ET)
850-872-4165 (CT)
is (are) located is different from No. 3 above, provide the
Gainesville Service Center
Pensacola Service Center
complete name.
2610 NW 43rd St Ste 2A
3670C N L ST
Gainesville FL 32606-7442
Pensacola FL 32505-5217
Physical Address: Enter the complete address where the
352-955-2170 (ET)
850-595-5170 (CT)
machine(s) is (are) located (DO NOT USE A POST OFFICE
BOX).
Hollywood Service Center
Port Richey Service Center
Taft Office Complex
6709 Ridge Rd Ste 300
Sales Tax Number for this Location: Enter the machine
6565 Taft St Ste 400
Port Richey FL 34668-6842
Hollywood FL 33024-4000
727-841-4407 (ET)
operator's sales tax number for this location. If you operate
954-967-1000 (ET)
machines in multiple locations, provide your sales tax number
Port Saint Lucie Service Center
used within the county of this location.
Jacksonville Service Center
900 E Prima Vista Blvd Ste 300
921 N Davis St A250
Port Saint Lucie FL 34952-2363
Maximum Number of Machines: Enter the actual number of
Jacksonville FL 32209-6829
561-871-7620 (ET)
machines operated/to be operated at this location. You may not
904-359-6070 (ET)
place more machines at a location than are shown on the
Sarasota Service Center
Key West Service Center
240 S Pineapple Ave Ste 600
certificate.
3118 Flagler Ave
Sarasota FL 34236-6725
Key West FL 33040-4698
941-361-6001 (ET)
Check One: If you are applying for the first certificate for this
305-292-6725 (ET)
location, check "new location." Enter the number of machines
Tallahassee Service Center
and multiply by $30. This is the fee amount that is due for this
Lake City Service Center
2410 Allen Rd
location. If you are adding machines to a previously issued
2651 W US Highway 90
Tallahassee FL 32312-2603
certificate, check "update" and give amusement machine
Lake City FL 32055-3173
850-488-9719 (ET)
certificate number. Enter the number of additional machines
904-758-0420 (ET)
Tampa Service Center
and multiply by $30. This is the fee amount that is due for this
Lakeland Service Center
Ste 100
location.
230 S Florida Ave Ste 101
6302 E Martin Luther King Blvd
Lakeland FL 33801-4622
Tampa FL 33619-1166
11.
Summary of Fee(s) Paid: Add all new machines on this
941-284-4244 (ET)
813-744-6344 (ET)
application and enter total here. Multiply total by $30. Enter this
dollar amount. This is the total fee due with this application.
Leesburg Service Center
West Palm Beach Service Center
Make checks payable to Florida Department of Revenue.
734 N 3rd St Ste 117
2468 Metrocentre Blvd
Leesburg FL 34748-4498
West Palm Beach FL 33407-3199
352-360-6660 (ET)
561-640-2800 (ET)
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