Gas And Sulfur Production Quarterly Tax Return Dr 144 Page 7

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DR-144ES
*** Detach Coupon ***
Office use only
R. 07/12
Florida Department of Revenue
M
M
D
D Y
Y
Declaration of Estimated Gas and Sulfur Production Tax
Installment
#_____
Use black ink. Example A - Handwritten Example B - Typed
0123456789
0 1 2 3 4 5 6 7 8 9
FEIN
M
M
D
D Y
Y
Quarter Ending
Name
M
M
D
D Y
Y
Applied Month
Address
City/St
Payment Amount
ZIP
(See reverse side)
US DOLLARS
CENTS
Do Not Write
Check here if you transmitted
Make checks payable and mail to:
Below this Line
funds electronically
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0150
9100 0 20139999 0012037033 7 3999999999 0000 2
DR-144ES
*** Detach Coupon ***
Office use only
R. 07/12
Florida Department of Revenue
M
M
D
D Y
Y
Declaration of Estimated Gas and Sulfur Production Tax
Installment
#_____
Use black ink. Example A - Handwritten Example B - Typed
0123456789
0 1 2 3 4 5 6 7 8 9
FEIN
M
M
D
D Y
Y
Quarter Ending
Name
M
M
D
D Y
Y
Applied Month
Address
City/St
Payment Amount
ZIP
(See reverse side)
US DOLLARS
CENTS
Do Not Write
Check here if you transmitted
Make checks payable and mail to:
Below this Line
funds electronically
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0150
9100 0 20139999 0012037033 7 3999999999 0000 2
DR-144ES
*** Detach Coupon ***
Office use only
R. 07/12
Florida Department of Revenue
M
M
D
D Y
Y
Declaration of Estimated Gas and Sulfur Production Tax
Installment
#_____
Use black ink. Example A - Handwritten Example B - Typed
0123456789
0 1 2 3 4 5 6 7 8 9
FEIN
M
M
D
D Y
Y
Quarter Ending
Name
M
M
D
D Y
Y
Applied Month
Address
City/St
Payment Amount
ZIP
(See reverse side)
US DOLLARS
CENTS
Do Not Write
Check here if you transmitted
Make checks payable and mail to:
Below this Line
funds electronically
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0150
9100 0 20139999 0012037033 7 3999999999 0000 2

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Parent category: Financial
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