Form Dr-1c - Application For Collective Registration For Rental Of Living Or Sleeping Accommodations - Florida Department Of Revenue - 2004 Page 2
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2DR-1C
R. 06/04
Florida Department of Revenue Service Centers
Alachua Service Center
Maitland Service Center
Pensacola Service Center
Fort Pierce Service Center
14107 US Highway 441 Ste 100
Benton Building
Ste 160
3670C N L St
Alachua FL 32615-6390
2301 Maitland Center Parkway
Pensacola FL 32505-5217
337 N US Highway 1 Ste 207-B
386-418-4444 (ET)
Fort Pierce FL 34950-4255
Maitland FL 32751-4192
850-595-5170 (CT)
407-475-1200 (ET)
772-429-2900 (ET)
Clearwater Service Center
Port Richey Service Center
Arbor Shoreline Office Park
Marianna Service Center
6709 Ridge Rd Ste 300
Hollywood Service Center
19337 US Highway 19 N Ste 200
Taft Office Complex
4230 Lafayette St Ste D
Port Richey FL 34668-6842
Marianna FL 32446-8231
727-841-4407 (ET)
Clearwater FL 33764-3149
6565 Taft St Ste 300
727-538-7400 (ET
Hollywood FL 33024-4044
850-482-9518 (CT)
Sarasota Service Center
954-967-1000 (ET)
Cocoa Service Center
Miami Service Center
Sarasota Main Plaza
2428 Clearlake Rd Bldg M
Jacksonville Service Center
8175 NW 12th St Ste 119
1991 Main St Ste 240
Cocoa FL 32922-5731
921 N Davis St A250
Miami FL 33126-1828
Sarasota FL 34236-5940
321-504-0950 (ET)
Jacksonville FL 32209-6829
305-470-5001 (ET)
941-361-6001 (ET)
904-359-6070 (ET)
Coral Springs Service Center
Naples Service Center
Tallahassee Service Center
Florida Sunrise Tower
3073 Horseshoe Dr S Ste 110
2410 Allen Rd
Key West Service Center
3111 N University Dr Ste 501
3118 Flagler Ave
Naples FL 34104-6145
Tallahassee FL 32312-2603
Coral Springs FL 33065-5090
239-434-4858 (ET)
850-488-9719 (ET)
Key West FL 33040-4602
954-346-3000 (ET)
305-292-6725 (ET)
Orlando Service Center
Tampa Service Center
Daytona Beach Service Center
Lake City Service Center
AmSouth Bank Building
Ste 100
1821 Business Park Blvd
5401 S Kirkman Rd 5th Floor
6302 E Martin Luther King Blvd
1401 W US Highway 90 Ste 100
Daytona Beach FL 32114-1230
Lake City FL 32055-6123
Orlando FL 32819-7911
Tampa FL 33619-1166
386-274-6600 (ET)
407-903-7350 (ET)
813-744-6582 (ET)
386-758-0420 (ET)
Fort Myers Service Center
Panama City Service Center
West Palm Beach Service Center
Lakeland Service Center
2295 Victoria Ave Ste 270
230 S Florida Ave Ste 101
703 W 15th St Ste A
2468 Metrocentre Blvd
Fort Myers FL 33901-3871
Panama City FL 32401-2238
West Palm Beach FL 33407-3105
Lakeland FL 33801-4625
239-338-2400 (ET)
863-499-2260 (ET)
850-872-4165 (CT)
561-640-2800 (ET)
Leesburg Service Center
CT—Central Time
1415 S 14th St Ste 103
ET—Eastern Time
Leesburg FL 34748-6686
352-315-4470 (ET)
Suggested format for rental property written agreement:
I, _____________________________________________ (Name of Property or Time-Share Period Owner), hereby
authorize _________________________________________________________________ (Name of Agent, Representative,
or Management Company) to act as my agent to rent, lease, let, or grant a license to others to use my described property
(properties) or time-share period (periods) located at _______________________________________________________
(use additional paper, if necessary) and to charge, collect, and remit sales tax levied under Chapter 212, Florida Statutes (F.S.),
to the Department of Revenue. I acknowledge that, by renting, leasing, letting, or offering a license to others to use any transient
accommodations, as defined in Rule 12A-1.061, Florida Administrative Code (F.A.C.), I am exercising a taxable privilege under
Chapter 212, F.S., and as such acknowledge that I am ultimately liable for any sales tax due the State of Florida on such rentals,
leases, lets, or licenses to use. I fully understand that should the State be unable to collect any taxes, penalties, and interest due
from the rental, lease, let, or license to use my property, a warrant for such uncollected amount will be issued and becomes a lien
against my property until satisfied.
Signature of Property Owner/Lessor
Signature of Agent, Representative, or Management Company
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