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Form Gt-400211 - Registration Information Sharing And Exchange (Rise) Program Level-Two Agreement Page 4

GT-400211

R. 01/16

Page 4

RISE Program Level-two Information Sharing Agreement

_____________________________________/Florida Department of Revenue

(Print Name of Government Entity)

11. Information related to the audit assessments or the tax payment history of specified dealers may be

exchanged upon request by authorized employees of either party to this Agreement. Requests for

tax payment history information in the possession of the Department shall be made by an authorized

employee pursuant to paragraph 4.F. of this Agreement, in writing, to the manager of the Department

Service Center serving the Government Entity.

12. No information received by the Department from the Internal Revenue Service shall be disclosed under

this Agreement.

13. In the event that the Government Entity fails to fulfill its obligations for participating in the RISE

program in accordance with s. 213.0535, F.S., and this Agreement, the Department is authorized

to suspend the routine providing of tax information to the Government Entity and, in its role as

coordinator of the RISE program, is also authorized to recommend that other participants in the RISE

program suspend any information exchange activity with the Government Entity.

Approved:

____________________________

______________________________

Deputy Executive Director

Title:__________________________

Florida Department of Revenue

Office:_________________________

(Government Entity)

Signed at Tallahassee, Florida,

Signed at ____________________,Florida,

_____

___________

_____

___________,

this

day of

, 20____.

this

day of

20____.

Form Gt-400211 - Registration Information Sharing And Exchange (Rise) Program Level-Two Agreement Page 4