Form Dr-907 - Florida Insurance Premium Installment Payment - 2006
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1
2
3DR-907
HD/PM Date:
/
/
Florida Insurance Premium Installment Payment
R. 01/08
US Dollars
Cents
,
,
FEIN
Florida Code
1. Premium tax payable
2. surcharge
,
a. commercial policies
Business Partner Number
# _________________ x $4
DR-907
,
b. residential policies
# _________________ x $2
Payment Number 1 Tax Year
,
3. interest
Due April 15
,
4. Penalty
Name
,
5. Quarterly statement filing fee
Address
City/st/ZiP
,
,
6. Amount due
Do Not Write in the space Below
❑
Check here if you transferred payment electronically.
Be sure to sign and date reverse side.
9100 0 20089999 0016045033 4 3999999999 0000 2
Mail form and remittance to:
FloriDA DePArTmeNT oF reveNue
5050 W TeNNessee sTreeT
TAllAhAssee Fl 32399-0150
DR-907
HD/PM Date:
/
/
Florida Insurance Premium Installment Payment
R. 01/08
US Dollars
Cents
,
,
FEIN
Florida Code
1. Premium tax payable
2. surcharge
,
a. commercial policies
Business Partner Number
# _________________ x $4
DR-907
,
b. residential policies
# _________________ x $2
Payment Number 2 Tax Year
,
3. interest
Due June 15 (estimate premiums through June 30)
,
4. Penalty
Name
,
5. Quarterly statement filing fee
Address
City/st/ZiP
,
,
6. Amount due
Do Not Write in the space Below
❑
Check here if you transferred payment electronically.
Be sure to sign and date reverse side.
Mail form and remittance to:
9100 0 20089999 0016045033 4 3999999999 0000 2
FloriDA DePArTmeNT oF reveNue
5050 W TeNNessee sTreeT
TAllAhAssee Fl 32399-0150
DR-907
HD/PM Date:
/
/
Florida Insurance Premium Installment Payment
R. 01/08
US Dollars
Cents
,
,
FEIN
Florida Code
1. Premium tax payable
2. surcharge
,
a. commercial policies
Business Partner Number
# _________________ x $4
DR-907
,
b. residential policies
# _________________ x $2
Payment Number 3 Tax Year
,
3. interest
Due october 15
,
4. Penalty
Name
,
5. Quarterly statement filing fee
Address
City/st/ZiP
,
,
6. Amount due
Do Not Write in the space Below
❑
Check here if you transferred payment electronically.
Be sure to sign and date reverse side.
Mail form and remittance to:
9100 0 20089999 0016045033 4 3999999999 0000 2
FloriDA DePArTmeNT oF reveNue
5050 W TeNNessee sTreeT
TAllAhAssee Fl 32399-0150
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