Form Dr-1 - Florida Business Tax Application Page 10
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10DR-1
R. 01/15
Page 10
Authorized
Signature – Depending on your business structure, only the following principal persons may sign this application:
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If the applicant is a sole proprietor, the individual owner must sign.
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If the applicant is a partnership, a general partner must sign.
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If the applicant is a corporation, an incorporator or officer must sign.
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If the applicant is a limited liability company, a member or manager (if authorized by the members) must sign.
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If the applicant is a trust, the grantor or a trustee must sign.
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If the applicant is an estate, the personal representative, executor or executrix must sign.
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If the applicant is a government agency, an official authorized to sign on behalf of the agency must sign.
Note: The person signing the application must be listed under item 12 in the Business Structure & Ownership section.
Applicant Attestation, Declaration, and Signature
Under penalties of perjury, I attest that I am the applicant, or that I am an authorized principal of the applicant entity identified herein, and also declare that I have
read the information provided on this application and that the facts stated in it are true.
Title: _ ______________________________________
Signature: __________________________________________________________________________________
Date: _ ______________________________________
Printed name: _______________________________________________________________________________
Amount enclosed: $ ____________
• $ 5 fee – Sales tax registration for business location or rental property located in Florida
• $30 fee – Solid waste fee & surcharge registration for dry cleaners
USE THIS CHECKLIST TO ENSURE FAST PROCESSING OF YOUR APPLICATION.
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You may also mail or deliver your application to any
Complete all required sections of this application.
Department of Revenue taxpayer service center. Scan
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Make sure that you have provided your FEIN or SSN.
the QR code to view the list of locations and telephone
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Sign and date the application.
numbers on your mobile device, or go to our website
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Attach check or money order for appropriate registration
fee(s). DO NOT SEND CASH.
a Attach required documentation or additional applications, if
applicable.
Mail to: Account Management MS 1-5730
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Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0160
FOR DOR USE ONLY
PM/Delivery
Contract Object (MO)
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B.P. No.
Certificate No.
RT Acct. No.
Contract Object (other)
NAICS Code(s):
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