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DR-350907

R. 10/06

Page 2

Instructions for Completing Form DR-350907

Who must use this form?

Step 4. Obtain authorization. If the change to the

database affects only your jurisdiction, complete

Special Fire Control Districts participating in the Local

Part A of the Official Authorization section. If the change

Insurance Premium Tax associated with a Firefighters’

affects a participating municipality or another Special

Pension Trust Fund under Chapter 175, Florida Statutes

Fire Control District participating in providing pension

must use Form DR-350907 to notify the Department of

benefits to firefighters as provided under Chapter 175

Revenue (DOR) of jurisdiction changes.

Florida Statutes, complete Parts A and B. To facilitate

processing of address database changes, the local

Note: All jurisdiction change requests must be submitted

jurisdiction requesting the change should attempt to

via the Department of Revenue’s Internet site at

obtain the written consent of the affected jurisdiction

Competent evidence for the

(signature in Part B). The name of the authorizing official

jurisdiction change must be submitted with this form.

should be the address database contact person for that

Section 175.101(1), Florida Statutes states that the

jurisdiction. Participating Special Fire Control Districts

local insurance premium tax is imposed only on policies

can access a list of contact persons on the Internet at

covering property “within the corporate limits of such

municipalities or within the legally defined boundaries of

Special Fire Control Districts can also call the

special fire control districts, respectively.”

Department’s Local Government Unit at 800-352-3671

for this information. Complete Part C only if you have

Changes submitted online without filing this form and

attempted to obtain the signature of the authorizing

the proper competent evidence attachments will not be

official and have been unable to do so.

considered.

Step 5. Attach competent evidence to this form. Mark

How to submit jurisdiction changes

each piece of evidence with the online case number.

Step 1. Set up online access. Obtain your access code

Some examples of competent evidence are:

for the online

database from DOR.

address/jurisdiction

• Plat

Log on to the database at and

• Ordinance

establish your profile.

• Survey

Step 2. Submit changes online. After reviewing the

• Annexation approval

current address/jurisdiction database, submit your

• Map

jurisdiction changes either by using the online entry

• Permit(s)

screen or batch process. When the changes are

Step 6. Submit Form DR-350907 (with competent

successfully submitted, you will receive a case number.

evidence attached ) to DOR.

All jurisdiction changes must be submitted to DOR via the

online database, unless otherwise approved.

Mail to:

Florida Department of Revenue

Step 3. Complete Form DR-350907. Enter the name

Local Government Unit

of the jurisdiction initiating the change and the effective

PO Box 6530

date of the change. Changes must be provided by

Tallahassee, FL 32314-6530

September 3rd each year. Enter the case number you

received online. The case number is assigned by the

For overnight or other delivery requiring a street address,

Department’s address database once change records

use:

are submitted. Check the box that corresponds to the

Florida Department of Revenue

type of jurisdiction change and indicate whether the

Local Government Unit

change affects a municipality or another Special Fire

Mail Stop 1-5700

Control District participating in providing pension benefits

5050 W Tennessee St

to firefighters as provided under Chapter 175, Florida

Tallahassee, FL 32399-0130

Statutes. If the answer is “yes,” enter the name of the

Or Fax to: 850-921-4711

municipality or Special Fire Control District in the space

provided.

For more information, call the Department’s Local

Government Unit at 800-352-3671 or e-mail to:

local-govt-unit@dor.state.fl.us.

Persons with hearing or speech impairments may call our

TDD at 800-367-8331 or 850-922-1115.

Form Dr-350907 - Local Insurance Premium Tax Special Fire Control Districts Notification Of Jurisdiction Change Page 2

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