Form Dr-342000 - Request To Participate In The Certified Audit Program (Page 4 of 5) in pdf

DR-342000

R. 01/16

23d. Gross Receipts Tax (Chapter 203, F.S., Gross Receipts Tax Return DR-133):

Page 4

Yes

Do you sell, deliver or transport electricity and/or natural or manufactured gas (except liquefied petroleum (L.P.) gas)

in Florida?

Do you own or operate an electric, a natural or a manufactured gas distribution facility in Florida that transmits,

delivers, or sells electricity and/or natural or manufactured gas?

Are you a natural gas transmission company that is subject to the jurisdiction of the Federal Energy Regulatory

Commission?

Do you import utility services into Florida for your own use?

Do you provide the wholesale sale of electric transmission services?

Are you eligible for an exemption under the industrial classifications listed in Section 212.08(7)(ff)2., F.S., for use as

an energy source or a raw material?

Do you use natural gas in the production of oil or gas or consume natural or manufacturing gas while transporting

natural or manufactured gas services?

23e. Insurance Premium Tax (Chapter 624, F.S., Insurance Premium Taxes and Fees Return, Form DR-908):

Yes

Is the entity a surplus lines agent writing surplus lines property insurance?

Does the entity write insurance policies or contracts covering property, subjects, or risks located, resident, or to be

performed in Florida, excluding warranty premiums?

Does the entity have receipts on annuity policies or contracts paid by holders in Florida?

Is the entity licensed to write insurance policies?

Is the entity a Risk Retention Group domiciled in Florida and registered with the Florida Office of Insurance

Regulation?

Is the entity a commercial, group pooling, or medical malpractice self insurer?

Is the entity an assessable mutual insurer?

Is the entity a fraternal benefit society?

Is the entity a Joint Underwriting Association?

Is the entity an industrial captive insurer?

Is the entity a legal domicile of the State of Florida?

23f. Motor Fuel Tax (Chapter 206, F.S., Refer to Rule 12B-5.150, F.A.C., for appropriate form):

Yes

Does the entity sell motor fuel, diesel fuel or aviation fuel in Florida at wholesale?

Does the entity sell motor fuel, diesel fuel or aviation fuel in Florida at retail?

Does the entity operate any delivery vehicles carrying fuel for sale or as delivery for others?

Does the entity purchase or use any fuels for highway purposes on which Florida’s highway tax has not been paid

to the supplier?

Does the entity sell or import any motor oils or solvent fuels into Florida?

If yes, list product types. ___________________________________________________________________________

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Form Dr-342000 - Request To Participate In The Certified Audit Program Page 4