Form Dr-142 - Solid Mineral Severance Tax Return - Florida Department Of Revenue

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Mail to:
DR-142
Solid Mineral Severance Tax Return
Florida Department of Revenue
R. 01/06
5050 W. Tennessee Street
Check here if amending your return
Tallahassee, Florida 32399-0150
DOR USe Only
POSTMaRk OR hanD DelIveRy DaTe
Use black ink. Example A - Handwritten Example B - Typed
0 1 2 3 4 5 6 7 8 9
0123456789
Certificate #
:
FEIN
:
Taxable Year
:
Return Due By :
Late After
:
Tax Due with Return Calculation
Complete Return Schedules First
US DOLLARS
CENTS
,
,
16. Gross Tax Due:
..................................................................... $
(from Lines 4, 8 and 15)
,
,
17. Sales Tax Credits:
........................................................................ $
(see instructions)
,
,
18. Payments and Other Credits:
18a. Estimated Tax Payments: ........................................................................... $
,
,
........................................................................ $
18b. Other Credits
(see instructions)
,
,
19. Total Tax Due: ..................................................................................................... $
,
,
20. Penalty: ............................................................................................................... $
,
,
21. Interest: ............................................................................................................... $
,
,
22. Total Due with Return: ....................................................................................... $
,
,
23. Credit: .................................................................................................................. $
,
,
24. Refund: ............................................................................................................... $
Under penalties of perjury, I declare that I have read the foregoing and the facts stated in it are true.
_____________________________________________________________________________________________________________________________
Signature of officer
Title
Phone number
Date
_____________________________________________________________________________________________________________________________
Signature of preparer
Address of preparer
Phone number
Date
Do Not Detach Coupon
DR-142
Solid Mineral Severance Tax Return
R. 01/06
To ensure proper credit to your account, enclose your check with this payment coupon and mail with tax return.
Return is due 1st day of the 4th month after close of the taxable year
Year
Y
M
M
D
D Y
US DOLLARS
Ending
CENTS
,
,
Total amount due
from Line 22
Check here if you transmitted funds electronically
,
,
Enter name and address, if not pre-printed:
Total credit
from Line 23
,
,
Total refund
from Line 24
FEIN
Enter FEIN if not pre-printed
DR-142
Do Not Write in the Space Below
0100 0 20059999 0013042031 4 3999999999 0000 2

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