Form Dr-350111 - Intangible Tax Self_audit Worksheet printable pdf download

DR-350111

Intangible Tax

R. 06/07

Self-Audit Worksheet – _____

Page 1 of 8

Name of taxpayer

FOR DEPARTMENT USE ONLY

DOC: 21

TAX: 03

Name of spouse

Address

City, State, ZIP

Taxpayer SSN

Spouse SSN

DR/SATS NO

schedule A

DOLLARS

CENTS

1. Bonds (from Schedule B, Line 9) ........................................... 1.

2. Stocks, mutual funds, money market funds and

limited partnership interest (from Schedule C, Line 10) ......... 2.

3. Loans, notes and accounts receivable

(from Schedule D, Line 11) ..................................................... 3.

4. Beneficial interest in any trust (from Schedule E, Line 12) ..... 4.

5. Total taxable assets (total of Lines 1 through 4) ..................... 5.

6. Tax due (from Tax Calculation Worksheet, Page 2, Line 6E) ............................... 6.

7. Interest

(from Interest Calculation Worksheet, Page 4, Line 13) ....................................... 7.

0 0 0

0 0

8. Penalty (not applicable) ........................................................................................ 8.

9. Total due (Line 6 + Line 7) .................................................................................... 9.

FOR YEARS 1999 AND AFTER, IF YOUR TAx DUE IS LESS ThAN $60.00,

YOU ARE NOT REqUIRED TO PAY ThE TAx DUE.

You may reproduce this self-audit form as necessary for disclosing your liability for years other than the target

year. Should you have additional questions, please call our service center at 850-488-0810 and ask to speak with

a tax auditor.

______________________________________

_____________________________________

______________________________________

Taxpayer signature

Spouse signature

Telephone number

______________________________________

_____________________________________

______________________________________

Date

Individual or firm preparing the worksheet

Telephone number

ThIS WORkShEET MUST bE RETURNED

Make checks

payable to:

Florida Department of Revenue

TO cLEAR YOUR AccOUNT.

Mail to:

TALLAhASSEE CENTRAL SERvICE CENTER

P.O. BOX 6417

YOUR RESPONSE IS REqUIRED WIThIN 30 DAYS.

TALLAhASSEE, FL 32314-6417

Neither foreign currency nor funds drawn on other than U.S. banks will be accepted. Florida law requires a

service fee for returned checks or drafts of fifteen ($15.00) dollars or five (5%) percent of the face amount,

whichever is greater, not to exceed $150.00 (s. 215.34(2), F.S.)

Form Dr-350111 - Intangible Tax Self_audit Worksheet

Related Articles

Related forms

Related Categories