Form Dr-1 - Florida Business Tax Application Page 7

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DR-1

R. 01/15

Page 7

Claims – Mail notices of benefits paid and other correspondence

about claims and benefits to (check one):

Payroll address (item 38)

Other, below

( )

Name:

Telephone number:

Mailing address:

City/State/ZIP:

Email address:

Section F - Activities Subject to Communications Services Tax

(no fee)

40. Do you sell communications services; purchase communications services to integrate into prepaid calling arrangements;

or are you applying for a direct pay permit for communications services tax? .........................................................................................................

If yes, check the box next to each service you sell, and answer questions 41-44. If no, skip Section F (questions 41-44).

Telephone service (i.e., local, long distance, wireless or VOIP)

Video service (e.g., television programming)

Paging service

Direct-to-home satellite service

Facsimile (fax) service (not in the course of advertising or professional services)

Pay telephone service

Reseller (only sales for resale; no sales to retail customers)

Purchase services to integrate into prepaid calling arrangements

Other services; please describe: _______________________________________________________________________________________________________________

41. Are you applying for a direct pay permit for communications services tax? ......................................................................................................................

If yes, also complete an Application for Self-Accrual Authority/Direct Pay Permit (Form DR-700030).

42. In order to charge the correct amount of tax, you must know the taxing jurisdiction in which your customers are located. How will you verify the correct

assignment of customer location to taxing jurisdiction? If you use multiple databases, check all that apply. If you sell only pay telephone or direct-to-home

satellite services, provide prepaid calling arrangements, are a reseller, or are applying for a direct pay permit, skip to item 44.

1. An electronic database provided by the Department.

2. Your own database that will be certified by the Department; to apply for certification, you must complete an Application for Certification of Communications Services

Database (Form DR-700012).

3. A database supplied by a vendor. Provide the vendor name and product: Vendor: _ ______________________________Product: _ _____________________________

4. ZIP+4 and a methodology for assignment when ZIP codes overlap jurisdictions.

5. ZIP+4 that does not overlap jurisdictions (e.g., a hotel located in one jurisdiction).

6. None of the above.

43. If you use multiple databases, you may be eligible for both collection allowances. If you will file separate returns for each type of database, check the box

below. See instructions for explanation.

I will file two separate communications services tax returns, one for each type of database.

44. Name and contact information of the managerial representative who can answer questions about filed tax returns:

( )

Telephone number:

Name:

Mailing address:

City/State/ZIP:

Email address:

Section G - Activities Subject to Documentary Stamp Tax

(no fee)

45. Do you make sales, finalized by written financing agreements, that are not recorded by the Clerk of the Court,

but do require documentary stamp tax to be paid? .......................................................................................................................................................

If yes, complete items a-b. If no, skip to question 46.

Do you anticipate five or more transactions subject to documentary stamp tax per month? ...............................................................................................................