Form Dr-42e - Application For Extension Of 90-Day Decal To 180 Days

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DR-42E
R. 10/10
Application for Extension of 90-Day Decal to 180 Days
Rule 12A-1.097
Florida Administrative Code
Purchaser Information
Name of Purchaser _____________________________________________________________________________________________
Address _______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Boat Hull # ________________________________________
Year ____________________________________________________
90-Day Decal # ____________________________________
Purchase Date of the Boat ________________________________
Date Application was Submitted to the Selling Dealer ______________________________________________________________
Selling Dealer Information
Name of Selling Dealer _________________________________________________________________________________________
Address _______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Florida Sales Tax Number of Selling Dealer ________________________________________________________________________
Phone # ___________________________
Amount Enclosed $ 425.00
Under penalties of perjury, I declare that I have read the foregoing, and that the facts stated in it are true.
____________________________________________________
____________________________________________________
Signature of Purchaser
Signature of Selling Dealer
____________________________________________________
____________________________________________________
Date
Date
Mailing Address:
Overnight Mailing Address:
Compliance Campaigns
Compliance Campaigns - Room 1-2800
Florida Department of Revenue
Florida Department of Revenue
PO Box 6417
5050 W Tennessee ST
Tallahassee FL 32314-6417
Tallahassee FL 32399-0133

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