Dr1 Florida Business Tax Application Page 10
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10DR-1
R. 01/15
Page 10
Authorized
Signature – Depending on your business structure, only the following principal persons may sign this application:
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If the applicant is a sole proprietor, the individual owner must sign.
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If the applicant is a partnership, a general partner must sign.
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If the applicant is a corporation, an incorporator or officer must sign.
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If the applicant is a limited liability company, a member or manager (if authorized by the members) must sign.
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If the applicant is a trust, the grantor or a trustee must sign.
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If the applicant is an estate, the personal representative, executor or executrix must sign.
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If the applicant is a government agency, an official authorized to sign on behalf of the agency must sign.
Note: The person signing the application must be listed under item 12 in the Business Structure & Ownership section.
Applicant Attestation, Declaration, and Signature
Under penalties of perjury, I attest that I am the applicant, or that I am an authorized principal of the applicant entity identified herein, and also declare that I have
read the information provided on this application and that the facts stated in it are true.
Signature: __________________________________________________________________________________
Title: _ ______________________________________
Printed name: _______________________________________________________________________________
Date: _ ______________________________________
• $ 5 fee – Sales tax registration for business location or rental property located in Florida
Amount enclosed: $ ____________
• $30 fee – Solid waste fee & surcharge registration for dry cleaners
USE THIS CHECKLIST TO ENSURE FAST PROCESSING OF YOUR APPLICATION.
You may also mail or deliver your application to any
Complete all required sections of this application.
a
Department of Revenue taxpayer service center. Scan
Make sure that you have provided your FEIN or SSN.
a
the QR code to view the list of locations and telephone
Sign and date the application.
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numbers on your mobile device, or go to our website
Attach check or money order for appropriate registration
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fee(s). DO NOT SEND CASH.
a Attach required documentation or additional applications, if
applicable.
Mail to: Account Management MS 1-5730
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Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0160
FOR DOR USE ONLY
PM/Delivery
Contract Object (MO)
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B.P. No.
Certificate No.
RT Acct. No.
Contract Object (other)
NAICS Code(s):
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