Form F-7004 - Florida Tentative Income / Franchise And/or Emergency Excise Tax Return

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Florida Department of Revenue - Corporate Income Tax
Florida Tentative Income / Franchise and/or Emergency Excise Tax
F-7004
Return and Application for Extension of Time to File Return
R. 01/03
FEIN
Name
Address
Taxable year end:
Corporation Partnership
City/St/ZIP
FILING STATUS
(Mark "X" in
one box only)
US DOLLARS
CENTS
Under penalties of perjury, I declare that I have been authorized by the above-named
Tentative tax due
taxpayer to make this application, and that to the best of my knowledge and belief the
(See reverse side)
statements herein are true and correct:
Sign
Check here if you transmitted funds
here: ____________________________________
Date: ____________________________________
electronically
9999090999999990000200503003039999999990999904

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