Form F-7004 - Florida Tentative Income Page 2

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ATX
Florida Department of Revenue
Make checks payable and mail to:
Florida Tentative Income / Franchise and Emergency Excise Tax
FLORIDA DEPARTMENT OF REVENUE
F-7004
5050 W TENNESSEE STREET
Return and Application for Extension of Time to File Return
R. 01/98
TALLAHASSEE FL 32399-0135
Photocopies of this form are not acceptable
0 1 2 3 4 5 6 7 8 9
If Typing, Type
You Must Write
0123456789
(example)
(example)
Through the Boxes.
Within the Boxes.
Form your numbers as shown and write one number per box.
FEIN
Taxable Year End:
Corporation Partnership
Name
_______________________________________
FILING STATUS
M
M
Y
Y
(Mark "X" in
Address
____________________________________
one box only)
Address
____________________________________
DOLLARS
CENTS
City/State/Zip
________________________________
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, that to the
Just Value
best of my knowledge and belief the statements herein are true
Intangible Tax Notice
$
and correct, and that I am:
Per Share
Sign
(Enter “0,” “1,” or “2”)
Here: _____________________________
Date: ___________
Mark (X) here if you
transmitted funds electronically
Florida Department of Revenue
Make checks payable and mail to:
Florida Tentative Income / Franchise and Emergency Excise Tax
FLORIDA DEPARTMENT OF REVENUE
F-7004
5050 W TENNESSEE STREET
Return and Application for Extension of Time to File Return
R. 01/98
TALLAHASSEE FL 32399-0135
Photocopies of this form are not acceptable
0 1 2 3 4 5 6 7 8 9
You Must Write
If Typing, Type
0123456789
(example)
(example)
Within the Boxes.
Through the Boxes.
Form your numbers as shown and write one number per box.
FEIN
Taxable Year End:
Corporation Partnership
Name
_______________________________________
FILING STATUS
M
M
Y
Y
(Mark "X" in
Address
____________________________________
one box only)
Address
____________________________________
DOLLARS
CENTS
City/State/Zip
________________________________
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, that to the
Just Value
best of my knowledge and belief the statements herein are true
Intangible Tax Notice
$
and correct, and that I am:
Per Share
Sign
(Enter “0,” “1,” or “2”)
Here: _____________________________
Date: ___________
Mark (X) here if you
transmitted funds electronically
Florida Department of Revenue
Make checks payable and mail to:
Florida Tentative Income / Franchise and Emergency Excise Tax
FLORIDA DEPARTMENT OF REVENUE
F-7004
5050 W TENNESSEE STREET
Return and Application for Extension of Time to File Return
R. 01/98
TALLAHASSEE FL 32399-0135
Photocopies of this form are not acceptable
0 1 2 3 4 5 6 7 8 9
You Must Write
If Typing, Type
0123456789
(example)
(example)
Through the Boxes.
Within the Boxes.
Form your numbers as shown and write one number per box.
FEIN
Taxable Year End:
Corporation Partnership
Name
_______________________________________
FILING STATUS
M
M
Y
Y
(Mark "X" in
Address
____________________________________
one box only)
Address
____________________________________
DOLLARS
CENTS
City/State/Zip
________________________________
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, that to the
Just Value
best of my knowledge and belief the statements herein are true
Intangible Tax Notice
$
and correct, and that I am:
Per Share
Sign
(Enter “0,” “1,” or “2”)
Here: _____________________________
Date: ___________
Mark (X) here if you
transmitted funds electronically

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