Form Dr-145x - Oil Production Monthly Amended Tax Return
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6Mail to:
DR-145X
Oil Production Monthly
Florida Department of Revenue
R. 07/12
Amended Tax Return
5050 W. Tennessee Street
TC
Rule 12B-7.008
Tallahassee Florida 32399-0150
Florida Administrative Code
Effective 05/13
Use black ink. Example A - Handwritten Example B - Typed
0 1 2 3 4 5 6 7 8 9
0123456789
Certificate #
:
FEIN
:
Name
Address
Applied Period :
City/St/ZIP
DOR USE ONLY
POSTMARK OR HAND-DELIVERY DATE
Tax Due with Return Calculation
Complete Return Schedules First
US DOLLARS
CENTS
,
,
1. Gross Tax Due
(Enter the sum of Schedule I Line 6, plus Schedule II Line 6, plus
................................................................................... $
Schedule III Line 6, plus Schedule IV Line 2)
,
,
2. Credit for Contributions to Nonprofit Scholarship Funding Organizations .......... $
,
,
3. DOR Credit Memo Issued
......................................................... $
(attach original credit memo)
,
,
4. Total Tax Due .............................................................................................................. $
,
,
5. Penalty ........................................................................................................................ $
,
,
6. Interest ........................................................................................................................ $
,
,
7. Total Due with Return ................................................................................................ $
,
,
8. Credited....................................................................................................................... $
,
,
9. Refunded ..................................................................................................................... $
Under penalties of perjury, I declare that I have read the foregoing and the facts stated in it are true.
___________________________________________________________________________________________________________________________________________
Signature of officer
Title
Phone number
Date
___________________________________________________________________________________________________________________________________________
Signature of preparer
Address of preparer
Phone number
Date
Do Not Detach Coupon
DR-145X
Oil Production Monthly Amended Tax Return
R. 07/12
Enclose your payment coupon and check with your tax return to ensure your account is properly credited.
Period
Y
M
M
D
D Y
US DOLLARS
CENTS
Ending
,
,
Total amount due
Check here if you transmitted funds electronically.
from Line 7
,
,
Enter name and address, if not preprinted:
Total credit
from Line 8
,
,
Total refund
Name
from Line 9
Address
FEIN
City/St/ZIP
Enter FEIN if not preprinted
DR-145X
Do Not Write in the Space Below.
9100 0 99999999 0052037049 6 3999999999 0000 2
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