Form F-7004 - Florida Tentative Income / Franchise Tax Return And Application For Extension Of Time To File Return

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Florida Department of Revenue - Corporate Income Tax
F-7004
Rule 12C-1.051
R. 01/13
Florida Tentative Income / Franchise Tax
Florida Administrative Code
Effective 01/13
Return and Application for Extension of Time to File Return
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
0123456789
(example)
(example)
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Name
Taxable year end:
Corporation Partnership
Address
FILING STATUS
M
M
D
D Y
Y
(Mark “X” in
one box only)
City/St/ZIP
US DOLLARS
CENTS
Tentative tax due
(See reverse side)
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Check here if you transmitted
Sign here:___________________________________________ Date:__________________
funds electronically
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
Make checks payable to and mail to:
9100 0 20129999 0002005030 3 3999999999 0000 2
Florida Department of Revenue - Corporate Income Tax
F-7004
Rule 12C-1.051
R. 01/13
Florida Tentative Income / Franchise Tax
Florida Administrative Code
Effective 01/13
Return and Application for Extension of Time to File Return
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
0123456789
(example)
(example)
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Name
Taxable year end:
Corporation Partnership
Address
FILING STATUS
M
M
D
D Y
Y
(Mark “X” in
one box only)
City/St/ZIP
US DOLLARS
CENTS
Tentative tax due
(See reverse side)
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Check here if you transmitted
Sign here:___________________________________________ Date:__________________
funds electronically
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
Make checks payable to and mail to:
9100 0 20129999 0002005030 3 3999999999 0000 2
Florida Department of Revenue - Corporate Income Tax
F-7004
Rule 12C-1.051
R. 01/13
Florida Tentative Income / Franchise Tax
Florida Administrative Code
Effective 01/13
Return and Application for Extension of Time to File Return
0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
0123456789
(example)
(example)
Write your numbers as shown and enter one number per box.
F-7004
FEIN
Name
Taxable year end:
Corporation Partnership
Address
FILING STATUS
M
M
D
D Y
Y
(Mark “X” in
one box only)
City/St/ZIP
US DOLLARS
CENTS
Tentative tax due
(See reverse side)
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Check here if you transmitted
Sign here:___________________________________________ Date:__________________
funds electronically
Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
Make checks payable to and mail to:
9100 0 20129999 0002005030 3 3999999999 0000 2

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