Form Dr-370060 Instructions - Refund Sampling Methodology Application For Sales And Use Tax Page 4
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NOTE: Submit one Refund Sampling Methodology Application per sample.
PART III – Statistical Sampling
Complete either Part II or Part III, not both.
A
Identify the sample selection method you will be using.
Simple random sample
Systematic random sample
Cluster, please explain
Without stratification
Without stratification
With stratification
With stratification
Other, please explain
Other, please explain
Describe the advantages of the chosen method. Attach a detailed description.
B
Explain your sampling plan in detail noting the following items.
C
7. For sample analysis:
1. Population size
6. If stratification is used:
a) Precision amount
2. Sample size
a) Method of determining stratum
b) Confidence level
3. Method used to determine sample
boundaries
c) Method used to calculate
size
b) Number of strata
precision
4. Method of selecting and using
c) Detail threshold amount
8. The estimator used (difference or
spares
ratio)
5. Method of calculating precision
9. Other pertinent sampling plan
information
Part IV must be completed.
PART IV – Certification
A
Under penalties of perjury, I declare that I have read the foregoing Refund Sampling Methodology Application and all
documents attached to it and that to the best of my information and belief the records referred to in them concerning the
refund request for the period________________ through ________________ are adequate and voluminous, as provided in
s. 212.12(6)(c), F.S., and in Rule 12-3.0012(3) and (4), F.A.C., for the entire period for which a refund is requested.
Name (Print or Type)
Federal Tax Identification Number
Signature and Title
Date
If the sampling will be conducted through either the Certified Audit Program or by C.P.A. attestation, selection (1) or (2) in
B
Question D of Part I of this form, Section B of Part IV must be completed and signed. If you have selected (3) in Question D
of Part I of this form, Section B of Part IV must be completed and signed or submit a complete set of audited financial
statements, with an unqualified opinion, for each fiscal year included in the refund period. For an incomplete current fiscal
year, you may submit unaudited financial statements.
I,_____________________________________________, certify that the above statement concerning the financial records
of _____________________________________________ in regards to the refund request filed with the Department of
Revenue under section 212.12(6)(c)3., F.S., is an accurate representation of such records as provided in s. 212.12(6)(c),
F.S., and in Rule 12-3.0012(3) and (4), F.A.C.
Name (Print or Type)
CPA license number
Signature
Date
CPA Firm Name
CPA Firm license number
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