Form Dr-700025 - Objection To Address-Jurisdiction Database For Local Communications Services Tax And Local Insurance Premium Tax Service Address Assignment

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DR-700025
Objection to Address/Jurisdiction Database for Local
R. 10/13
Communications Services Tax and Local Insurance
Rule 12A-19.100
Florida Administrative Code
Premium Tax Service Address Assignment
All requests can be submitted using the Department of Revenue’s Internet site at: https://pointmatch.state.fl.us
Part A: Contact Information
I am a (check one):
❏ Communications Services Provider
❏ Individual (insured or purchaser of communications services)
❏ FDOR Employee
❏ Insurance Company or Vendor
❏ Communications Services Tax Address Vendor
Name:_____________________________________________
Title: ______________________________________________________
Company: _________________________________________
Street Address: _____________________________________________
City/State/ZIP: _____________________________________
E-mail address: _____________________________________________
Phone Number: ____________________________________
Fax Number: _______________________________________________
Part B: Service Address Information
To submit an objection for multiple addresses, use the Department's Internet site at:
https://pointmatch.state.fl.us or contact us at 850-717-6630 for more information.
Required for all requests.
The service address I am objecting to has an effective date (if known) of: ________________________________________________
Number and Street________________________________________
City: ________________________________________________
County: _________________________________________________
ZIP: _________________________________________________
For FDOR Employees only. For SUNTAX related requests, provide all of the following:
Business Partner #: _______________________________________
Certificate #: _________________________________________
Tax Type: ________________________________________________
Owner Name (if not sole proprietor): ____________________
Account Name: __________________________________________
Owner Phone: _______________________________________
Part C: Basis for Objection
Complete the appropriate reason based on your objection (check all that apply).
Reason 1.
The address is listed in the wrong jurisdiction within the database. Current jurisdictional assignment is
______________________________________________. Proposed jurisdiction assignment should be
______________________________________________.
Reason 2.
The address is not listed in the database. Proposed jurisdiction assignment should be
______________________________________________.
Reason 3:
The address information is incorrect (EX. misspelled, wrong ZIP code). Proposed correction to address: _____
__________________________________________________________________________________________________
__________________________________________________________________________________________________
If none of these reasons apply, use the space below to describe your objection:
Reason 4:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

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