Form Dr-15jez-Application For The Exemption Of Electrical Energy Used In An Enterprise Zone 2009

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DR-15JEZ
Application for the Exemption of Electrical
R. 08/09
Energy Used in an Enterprise Zone
Rule 12A-1.097
Florida Administrative Code
Effective 06/10
Section 1
Name of business
Date of application
Business location address
Federal Employer Identification Number (FEIN) or Social Security Number (SSN)*
City
State
ZIP
Sales tax certificate number
Business mailing address
Telephone number
City
State
ZIP
Provide the identification number of the enterprise zone where the
business is located, as assigned by the Office of the Governor, Office
Check this box if the business qualifies as a small business as
of Tourism, Trade and Economic Development, pursuant to section
defined by section 288.703(1), Florida Statutes (F.S).
290.0065, F.S.
Section 2
Your exemption from tax of electrical energy used in an enterprise zone is
Utility company name
__________%. See Section 6 to calculate the percentage of exemption.
Utility company address
City
State
ZIP
Section 3
The electrical energy is to be first initiated______________________________for use by the applicant business at a fixed location which:
Month
Day
Year
(check one)
1.
Is a new initially occupied structure that has not been previously provided or furnished electrical service (other than that used
solely for construction purposes).
2.
Is a newly occupied existing, remodeled, renovated, or rehabilitated structure to which electrical service has not been pro-
vided or furnished in the three (3) preceding billing periods (other than that used solely for the purpose of remodeling, renova-
tion, or rehabilitation of the structure).
3.
Has been granted a refund on building materials, pursuant to s. 212.08(5)(g), Florida Statutes, (see Rule 12A-1.107, Florida
Administrative Code, governing building materials used in the rehabilitation of real property located in an enterprise zone.)
Section 4
Permanent, full-time employees (enterprise zone residents)
Name
Address
City, State, ZIP
SSN*
Enterprise Zone ID No.
(If necessary, attach a separate sheet listing name, address, city, state, ZIP, social security number and the identifying number assigned pursuant to
s. 290.0065, Florida Statutes, to the enterprise zone in which the permanent, full-time employee resides.)
*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs
obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public
records. Collection of your SSN is authorized under state and federal law. Visit our Internet site at and select “Privacy
Notice” for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions.

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