Form Dr-116000 - Application For Tax Credit Allocation For Contributions To Nonprofit Scholarship-Funding Organizations (Sfos)

ADVERTISEMENT

DR-116000
Application for Tax Credit Allocation for Contributions to
R. 07/15
Nonprofit Scholarship-Funding Organizations (SFOs)
TC
Rule 12-29.003
Florida Administrative Code
Effective 07/15
Business Name:
Federal Employer Identification Number (FEIN):
Business Address:
City:
State:
ZIP:
Contact Person Name:
Telephone Number:
Email Address:
Applying for (select one):
Contribution to nonprofit scholarship-funding organization
Enter the nonprofit scholarship-funding organization to which the contribution will be made. A separate
application is required for each organization: ______________________________________________________________________
Credit Carryforward – Original confirmation number: _______________________________________________________________
Total amount of planned contribution or credit carryforward: $ ___________________________________________________________
Indicate the amount of credit allocation for each applicable tax. The sum of the amounts must equal the planned contribution or
credit carryforward amount entered above.
$______________ Corporate Income Tax
Beginning Date of Tax Year: ________________
Ending Date of Tax Year: ____________________
$______________ Insurance Premium Tax
(For the current Calendar Year)
$______________ Excise Tax on Malt Beverages
For the Fiscal Year beginning July 1, ______________
Malt Beverage License Number: _____________________________________________________________
$______________ Excise Tax on Wine Beverages
For the Fiscal Year beginning July 1, ______________
Wine Beverage License Number: ____________________________________________________________
$______________ Excise Tax on Liquor Beverages
For the Fiscal Year beginning July 1, ______________
Liquor Beverage License Number: ___________________________________________________________
$______________ Sales and Use Tax due from a Direct Pay Permit Holder
For the Fiscal Year beginning July 1, ______________
Sales Tax Certificate Number: _______________________________________________________________
$______________ Tax on Oil Production
For the Fiscal Year beginning July 1, ______________
$______________ Tax on Gas Production
For the Fiscal Year beginning July 1, ______________
If you file a consolidated Florida corporate income tax return, you must provide the parent corporation’s name and FEIN.
Parent corporation _________________________________________________________________________________________________
Parent corporation’s FEIN
I understand that section (s.) 1002.395(5)(b)2., Florida Statutes (F.S.), requires the Florida Department of Revenue to provide
a copy of any approval it issues regarding this Application to the nonprofit scholarship-funding organization indicated in this
Application.
Under penalty of perjury, I declare that I have read this Application and that the facts stated in it are true.
_____________________________________________________
____________________________________
Signature of officer, owner, or partner
Date

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 3