Form Dr-700025 - Objection To Address/jurisdiction Database For Local Communications Services Tax And Local Insurance Premium Tax Service Address Assignment Page 2
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2DR-700025
R. 10/06
Page 2
Instructions for Completing Form DR-700025
Who may use this form?
Step 4. Complete Part D: Competent Evidence
This form may be used by a communications services
Competent evidence must be attached to this form.
dealer, purchaser of communications or insurance
Briefly describe the evidence you have attached in the
services, Communications Services Tax (CST) Vendor,
space provided. Examples of competent evidence
Insurance Premium Tax (IPT) vendor or other substantially
include:
affected party to object to information contained in the
• A voter registration card that indicates the voter
Department of Revenue’s address/jurisdiction database.
resides at a service address that is entitled to vote in
municipal elections or only in county elections.
This form may not be used by local taxing jurisdictions to
• A map that includes the boundaries of a local taxing
make corrections or updates to the address/jurisdiction
jurisdiction and clearly places a service address
database. Local taxing jurisdictions should use Form
inside or outside those boundaries.
DR-700022, Notification of Jurisdiction Change for Local
• Property tax bill.
Communications Services and Local Insurance Premium
Tax. Special Fire Control Districts should use Form
Communications services dealers in possession
DR-350907.
of MSAG/911 data may attach a written statement
indicating that the data was consulted.
Firefighters and police officers, including pension board
Step 5. Complete Part E: Sign and date the form.
members, with concerns about the Local Insurance
Premium Tax and the address/jurisdiction database
Mail to:
should communicate with the appropriate official within
Florida Department of Revenue
their local jurisdiction, either the city or special fire
Local Government Unit
district, regarding database address changes.
PO Box 6530
Step 1. Complete Part A: Contact Information
Tallahassee, FL 32314-6530
Step 2. Complete Part B: Address Information
For overnight or other delivery requiring a street address,
use:
If you are a communications services dealer, insurance
Florida Department of Revenue
company, CST or IPT vendor you are encouraged to use
Local Government Unit
the address range associated with the service address
Mail Stop 1-5700
you are objecting to. You may submit multiple addresses
5050 W Tennessee St
or ranges in this section but if so you are encouraged to
Tallahassee, FL 32399-0130
submit them electronically. Also see Step 3 regarding
multiple addresses or ranges. Be sure to use the most
Or Fax to: 850-921-4711
current version of the database for address information.
For communications services dealers, insurance
Step 3. Complete Part C: Basis for Objection
companies, CST or IPT vendors, send address diskettes
to the above address.
Check the box for the reason that applies to your
objection. You should check only one box per form.
Upon receipt of this form, the Department will contact the
If you are a communications services dealer, insurance
local jurisdiction(s) pursuant to departmental rules.
company, CST or IPT vendor and are submitting multiple
For more information, call the Department’s Local
addresses or ranges affecting multiple jurisdictions,
Government Unit at 800-352-3671 or e-mail to:
each combination should be segregated based on the
local-govt-unit@dor.state.fl.us.
specific combination of the affected jurisdictions and
basis for objections. You should use a separate form
Persons with hearing or speech impairments may call our
for each combination. (EX: Addresses or ranges moving
TDD at 800-367-8331 or 850-922-1115.
from City A to City B should be on one form. Addresses
or ranges moving from City A to City C should be on
a separate form.) You are encouraged to submit the
segregated information electronically by CD or diskette.
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