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Form Gt-400210 - Registration Information Sharing And Exchange (Rise) Program Level-One Agreement Page 3

GT-400210

R. 01/16

Page 3

RISE Program Level-one Information Sharing Agreement

_______________________________/Florida Department of Revenue

(Print Name of Government Entity)

County code (as provided by the Department).

Applicable state or local license or registration number, and any other unique identifying

number.

Business opening date.

Indication if new or re-issuance (not renewals or address changes).

9. Unless otherwise specified in Attachment A to this Agreement, information specified in paragraph 8 of

this Agreement shall be provided in a computer processable medium in the format found in

Attachment B of this Agreement.

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

this Agreement.

11. 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 that 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-400210 - Registration Information Sharing And Exchange (Rise) Program Level-One Agreement Page 3