Municipal Public Service Tax Database Report Form printable pdf download

Municipal Public Service Tax Database Report Form

DR-700001

Municipal Public Service Tax Database Report

R. 01/16

Rule 12B-6.0051

Florida Administrative Code

Effective 01/16

This form is intended to be used to comply with section 166.233(2), Florida Statutes. All Florida municipalities and charter counties must provide this information to the

Florida Department of Revenue, sending changes as they occur. Any change in a tax levy or rate must be reported at least 120 days before the change occurs.

Please fill in all information on each municipal public service not administered by a municipality, or its separate utility authority, board, or commission. (No information is

required for any service administered by a municipality or its separate authority, board, or commission.)

Note: Tax levies for communications services are no longer reported to the Department of Revenue using this form. To report communications service tax levies and levy

changes local officials must use form DR-700021.

Municipality _____________________________________________________________________ County_____________________________________________________________________

Service

New Tax

Effective Date

Government Contact

Telephone

Street/PO Box

City

ZIP Code

Rate**

Person

Gas:

Natural

Liquefied

Petroleum

Manufactured

Electric

Water

Fuel Oil/Kerosene

**Enter tax rate. If existing tax is repealed, enter “0%” for “New Tax Rate”. If voluntarily reporting self-administered tax, enter tax rate and “S/A.”

__________________________________________________

____________________________

_________________________________________________

____________________

Preparer Name

Preparer Phone

Preparer Signature

Date

Return completed form to:

John Crotty, RISE Coordinator

Phone

850-717-6430