Form Dr-843 - Purchaser'S Application For Transferee Liability Certificate printable pdf download

Form Dr-843 - Purchaser'S Application For Transferee Liability Certificate

DR-843

R. 04/10

Purchaser’s Application for

Transferee Liability Certificate

___________________________ has purchased or is purchasing a business or stock of goods from:

_____________________________________

(Name of Selling Dealer)

__________________________________________________

Address

__________________________________________________

City, State, ZIP Code

__________________________________________________

Business Partner Number

The purchaser is requesting a Transferee Liability Certificate for the period ___________________

through ___________________ .

Purchaser’s signature: ________________________ Telephone Number: __________________

Please attach documentation to this form to verify the sale or proposed sale of the business.

NOTE - The Department will only deliver the certificate to the seller of the business, unless the

department asserts transferee liability against you or other responsible person(s), based on the

contents of the certificate.

When complete, mail the form to:

General Tax Administration Program

Compliance Support Process

PO Box 5139

Tallahassee, FL 32314-5139

Phone: 850-922-5923

Fax: 850-488-0325

Form Dr-843 - Purchaser'S Application For Transferee Liability Certificate