Form Dr-1con - Application For Consolidated Sales And Use Tax Registration Page 2
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27.
Month of first consolidated filing (effective date is the first of the month; allow four weeks for processing): ________________
8.
List the complete Sales & Use Tax Number (as shown on your certificate, Form DR-11) for each business location you wish to
report under this consolidated number. Attach additional sheets, if necessary.
9.
Applicant Signature —This Application Cannot Be Processed If Not Signed by the Applicant.
I certify, under penalty of perjury, that the statements herein have been examined by me and are, to the best of my knowledge and
belief, true, complete and correct.
________________________________________________________
_________________________________
Signature of Business Owner, Principal Partner, or Corporate Officer
Date Application Signed
________________________________________________________
_________________________________
Print or Type the Name Signed Above
Title of Signatory
Please note that any person (including employees, corporate directors, corporate officers, etc.) who is required to collect, truthfully
account for, and pay any sales taxes and willfully fails to do so shall be personally liable for such taxes under the provisions of
s. 213.29, Florida Statutes.
Mail this completed application to:
Florida Department of Revenue
Registration Section
5050 W. Tennessee St.
Tallahassee, FL 32399-0100
There is no fee required for registering to file a consolidated return.
FOR DOR OFFICE USE ONLY
MO QU SA SE
SIC
Kind Code
Consolidated Number
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Parent category: Financial