Form Dr-309637 Sample - Petroleum Carrier Information Return - 2015 Page 3

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00002
DR-309637
Mail To:
Petroleum Carrier
Florida Department of Revenue
R. 01/13
5050 W Tennessee St
Information Return
Page 3
Tallahassee FL 32399-0165
For Calendar Year:
2015
❑
FEIN:
920002015999900970270372300000000100002
DOR USE ONLY
POSTMARK OR HAND-DELIVERY DATE
Complete Reverse Side of Return First
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

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