Form Dr-842 - Seller'S Application For Transferee Liability Certificate printable pdf download

Form Dr-842 - Seller'S Application For Transferee Liability Certificate

DR-842

R. 12/15

Seller’s Application for Transferee

Liability Certificate

The dealer referenced below, has sold or is selling his or her business or stock of goods, and

is applying for a Transferee Liability Certificate for the period __________ through ___________ .

Name of Selling Dealer: ____________________________________________

Mailing Address: __________________________________________________

City, State, ZIP: ___________________________________________________

Business Partner Number: ______________________

When the audit is complete, send the certificate to:

Name of Purchaser: _______________________________________________

Mailing Address: __________________________________________________

City, State, ZIP: ___________________________________________________

I give the Department permission to include in the certificate, information about the requested audit

which you may not, without permission, disclose without violating the confidentiality requirements of

section 213.053, Florida Statutes.

Signature of Owner or Representative of Selling Dealer:

____________________________________________

Name of Owner or Representative:

____________________________________________

(Please print)

Telephone Number:

____________________________________________

Mail to: General Tax Administration Program

Compliance Standards

PO Box 5139

Tallahassee, FL 32314-5139

Phone: 850-617-8565

Fax: 850-921-6174

Form Dr-842 - Seller'S Application For Transferee Liability Certificate