Form F-7004 - Florida Tentative Income / Franchise And/or Emergency Excise Tax Return And Application For Extension Of Time To File Return - 2005

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Florida Department of Revenue - Corporate Income Tax
Make checks payable and mail to:
Florida Tentative Income / Franchise and/or Emergency Excise Tax
FLORIDA DEPARTMENT OF REVENUE
F-7004
5050 W TENNESSEE ST
Return and Application for Extension of Time to File Return
R. 01/05
TALLAHASSEE FL 32399-0135
If typing, type
You must write
0 1 2 3 4 5 6 7 8 9
0123456789
(example)
(example)
through the boxes.
within the boxes.
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Taxable year end:
Corporation Partnership
Name
FILING STATUS
Address
(Mark "X" in
M
M
D
D Y
Y
one box only)
City/St/ZIP
US DOLLARS
CENTS
Tentative tax due
(See reverse side)
Under penalties of perjury, I declare that I have been authorized by the
above-named taxpayer to make this application, and that to the best of
my knowledge and belief the statements herein are true and correct:
Sign
here: _____________________________________ Date: ___________________
Check here if you transmitted
9000 0 20049999 0002005030 9 3999999999 0000 2
funds electronically

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