Form Dr-142 - Solid Mineral Severance Tax Return Page 7
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12DR-142ES
Declaration/Installment Payment
R. 01/13
of Estimated Solid Mineral Severance Tax
Rule 12B-7.026
Florida Administrative Code
Effective 05/13
For Year:
❑
Check here if this is an amended declaration
Certificate #
:
Name
FEIN
:
Address
Taxable Year
:
City/St/ZIP
Declaration is based on (check one):
80% of estimated production this year
■
Prior year’s return
■
A – Phosphate
B – Heavy
C – Other
Rock
Minerals
Solid Minerals
1. Expected Tonnage of Phosphate Rock, Heavy Minerals, or
Other Solid Minerals.
2. Expected Taxable Value of Other Solid Minerals
per ton
per ton
of value
3. Tax Rate for Taxable Year
4. Estimated Tax Due
(Line 3 multiplied by Line 1 or Line 2)
5. Total Estimated Tax Due (enter total of Line 4, Columns A, B, and C)
5. $ ______________________
6. Less Total Amount of Installments Paid to Date for this Taxable Year
(applies only if this is an amended declaration)
6. $ ______________________
7. Balance of Estimated Payments Due (Line 5 minus Line 6)
7. $ ______________________
8. Number of Remaining Payments this Year (4 installments per year)
8.
______________________
9. Amount of Installments
9. $ ______________________
(Line 7 divided by Line 8; enter here and on installment payment coupons)
*** Detach Coupon ***
DR-142ES
Florida Department of Revenue
R. 01/13
Declaration/Installment Payment of Estimated Solid Mineral Severance Tax
Handwritten Example
Typed Example
Installment
#_____
0 1 2 3 4 5 6 7 8 9
0123456789
Use black ink.
FEIN
Taxable
M
M
D
D Y
Y
Year End
Name
Installment Payment Amount
Address
(See reverse side)
City/St/ZIP
US DOLLARS
CENTS
,
,
Check here if you transmitted
Office use
M
M
D
D Y
Y
funds electronically.
Do Not Write Below this Line.
only
Make checks payable and mail to:
FLORIDA DEPARTMENT OF REVENUE
9100 0 99999999 0013042033 4 3999999999 0000 2
5050 W TENNESSEE ST
TALLAHASSEE FL 32399-0150
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