Form Dr-342000 - Request To Participate In The Certified Audit Program
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2DR-342000
Request to Participate in the Certified Audit Program
R. 10/11
1. Name of taxpayer:
2. Telephone number:
3. FAX number:
4. Mailing address of taxpayer:
Street or post office box:
City:
State:
ZIP Code:
5. Business location of taxpayer:
Street address:
City:
State:
ZIP Code:
6. Taxpayer FEIN:
7. Type of organization. Check the appropriate box.
Corporation
Partnership
Sole Proprietorship
Trust
S Corporation
Professional Association
Other (Specify) ________________________________________________________________________
8. Standard Industrial Classification Code(s):
9. Gross receipts. Provide the taxpayer’s gross receipts for the last fiscal year of the proposed audit period.
Year end:
Gross receipts: $
10. List all business names and registration numbers that were assigned and/or used by the taxpayer to report and remit
Sales and Use Tax within the last 3 years of the proposed audit period.
Business Name
Registration Number
11. CPA firm name:
12. CPA firm Florida practice unit CPA certificate number:
13. CPA firm FEIN:
14. Mailing address of CPA firm:
Street or post office box:
City:
State:
ZIP Code:
15. CPA firm telephone #:
16. CPA firm FAX #:
17. CPA firm E-mail address:
18. Provide the names and certification numbers of all CPA staff members who will be involved in the Certified Audit.
Also, provide names of all non-CPA staff members who will be involved in the Certified Audit program.
Name
CPA Certificate Number
DOR Certification Number
Role on Engagement
19. Is this request to participate in the Certified Audit Program to request a refund by using a sampling method to
establish the amount of refund?
Yes ______ No ______ If yes, attach form DR-26S and DR-370060 along with the information required by the forms.
20. Provide the tax and audit period to be included in the Certified Audit. The tax and audit period are subject to
approval by the Department of Revenue.
Tax:
Audit Period:
21. Attach a comprehensive, detailed list of all services your firm has provided the taxpayer.
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