Form DR-1 Fillable Florida Business Tax Application R.01/15
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$30 fee Solid waste fee & surcharge registration for dry cleaners (1) Pest control services for nonresidential buildings (4) Protection services (2) Interior cleaning services for nonresidential buildings (5) Security alarm system monitoring services (3) Detective services (e g different contacts banking information methods of payment) you may do so online after you have received all certificate and account numbers following **Refers to elections made for federal income tax |: :| 1 An electronic database provided by the Department 2 Your own database that will be certified by the Department; to apply for certification you must complete an Application for Certification of Communications Services 3 A database supplied by a vendor Provide the vendor name and product: Vendor: Product: 4 ZIP+4 and a methodology for assignment when ZIP codes overlap jurisdictions 5 ZIP+4 that does not overlap jurisdictions (e g a hotel located in one jurisdiction) 5050 W Tennessee St 6 None of the above a company employee a non related tax preparer the party named in item 38 a Do you anticipate five or more transactions subject to documentary stamp tax per month? Y N a Domestic or international long distance calling/phone cards (non wireless) a Electricity Natural or manufactured gas a Extracting oil for sale transport storage profit or commercial use a Regular Indian tribe/Tribal unit or Governmental employer a Sole proprietorship Agricultural (citrus) employer Agricultural (noncitrus) employer Agricultural crew chief All Part Unknown b Do you import into Florida natural or manufactured gas (excluding LP gas) for your own use instead of purchasing taxable utility or transportation services? Y N b Extracting gas for sale transport profit or commercial use b Partnership (check one below) b Prepaid wireless services (cards plans devices) that provide access to wireless networks and interaction with 911 emergency services Business or Personal and Checking or Savings but do require documentary stamp tax to be paid? Y N c Corporation (check one below) C corporation Not for profit corporation c Extracting sulfur for sale transport storage profit or commercial use City/State/ZIP: Complete this section if you wish to electronically file and pay all taxes fees and surcharges resulting from this registration if an electronic option exists Each d Extracting solid minerals phosphate rock or heavy minerals from the soil or water for commercial use Domestic employer (household & personal care) e Business trust e Extracting lime rock or sand from within the Miami Dade County Lake Belt Area (see s 373 4149 F S for boundary description) Elects treatment as C corporation ** f Nonbusiness trust/Fiduciary Facsimile (fax) service (not in the course of advertising or professional services) Pay telephone service Fail or refuse to collect a required tax surcharge or fee Fail or refuse to register (a late registration fee or penalty may also be imposed) File Electronically Pay Electronically (select one): ACH Debit (e check) ACH Credit Florida Department of Revenue Florida employers are required to obtain appropriate workers compensation insurance coverage for their employees visit g Estate Gas station only Gas station/convenience store Truck stop Marine fueling Aircraft fueling Governmental entity h Government agency Have you or will you employ four or more workers for 20 or more weeks within a calendar year? ** Y N Have you or will you pay gross wages of at least $1 000 within a calendar quarter? ** Y N Have you or will you pay gross wages of at least $1 500 within a calendar quarter? ** Y N Have you or will you pay gross wages of at least $10 000 within a calendar quarter? ** Y N I understand it is my responsibility to notify the Department of Revenue of any changes of business structure activities location mailing address or contact I understand that any person who is required to collect truthfully account for and pay any tax surcharge or fee and willfully fails to do so shall be personally I will file two separate communications services tax returns one for each type of database If no skip Section E (questions 29 39) If the applicant is a corporation an incorporator or officer must sign If the applicant is a government agency an official authorized to sign on behalf of the agency must sign If the applicant is a limited liability company a member or manager (if authorized by the members) must sign If the applicant is a partnership a general partner must sign If the applicant is a sole proprietor the individual owner must sign If the applicant is a trust the grantor or a trustee must sign If the applicant is an estate the personal representative executor or executrix must sign If yes also complete a Florida Fuel or Pollutants Tax Application (Form DR 156) If no continue to question 28 If yes also complete an Application for Self Accrual Authority/Direct Pay Permit (Form DR 700030) If yes also complete an Independent Contractor Analysis (RTS 6061) If yes answer question a If no skip to question 22 If yes answer questions a c If no skip to question 26 If yes answer questions a d If no skip to question 23 If yes check the box next to each activity below that describes your sales If yes check the box next to each activity you are engaged in If no skip to question 48 If yes check the box next to each service you sell and answer questions 41 44 If no skip Section F (questions 41 44) If yes complete item a If no skip to question 24 If yes complete items a b If no skip to question 46 If yes complete items a f about the leasing company and your leasing arrangement If yes enclose the $30 dry cleaning registration fee If no continue to question 27 If yes in which state: in which year: If yes provide location information: If yes provide name address and telephone number of machine operator: If no also complete an Application for Amusement Machine Certificate (Form DR 18) If yes provide the date of the 20th week: If yes provide the date of the 20th week: If yes provide the date you reached or will reach $1 000 gross wages: If yes provide the date you reached or will reach $1 500 gross wages: If yes provide your RT Account Number and skip questions 30 39 RT Account Number If yes provide your RT Account Number RT Account Number Indian tribe or Tribal unit Limited partnership Joint venture Link new county location to Make a worthless check draft debit card payment or electronic funds transfer to the Department Married couple General partnership Multi member LLC New Florida employers must register with the Florida New Hire Reporting Center to report newly hired and re hired employees in Florida visit Nonprofit organization (attach a copy of your 501(c)(3) Not remit a collected tax surcharge or fee Not timely file a tax return or report Note: The person signing this application must be listed here or are you applying for a direct pay permit for communications services tax? Y N Other services; please describe: Paging service Direct to home satellite service Payroll address (item 38) Other below Payroll address (item 38) Other below Provide date of death: Regular employer (employee leasing companies attach Reseller (only sales for resale; no sales to retail customers) Purchase services to integrate into prepaid calling arrangements S corporation Single member LLC such as new automobiles golf carts or boats? Y N Tallahassee FL 32399 0160 Telephone service (i e local long distance wireless or VOIP) Video service (e g television programming) Underreport a tax surcharge or fee liability on a return or report filed Yes No Yes No Yes No Yes No You may also mail or deliver your application to any Your email address is treated as confidential information [section (s) 213 053 Florida Statutes (F S )] and is not subject to disclosure of public records (s 119 071 F S ) (Attach additional pages if necessary) (check one): (for sole proprietor only): (Form DR 1S) (If account requires two signatures) * 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 ** Officers performing services for the corporation and receiving payment for such services (salary or distributions) are considered employees of the 1 Indicate your reason for submitting this application (check only one; provide date and certificate number if applicable) 10 Check the box next to the structure of your business entity 11 Corporations partnerships limited liability companies and trusts must provide the following: 12 Identify the owner/sole proprietor or general partners officers managing members grantors trustees or personal representatives of the business entity 13 Has this business entity ever been known by 14 Has this business entity ever been issued a certificate of registration certificate number or tax account number by the Florida Department 15 Has any owner/proprietor partner officer member trustee or the person whose social security number is provided in items 8c or 12 ever 15 provide the name address and certificate 16 If you answered Yes to questions 14 or 17 Has a tax warrant ever been filed by the Florida Department of Revenue against this business entity? 18 Has a tax warrant ever been filed by the Florida Department of Revenue against any owner/proprietor partner officer member trustee or the person 19a Describe the primary nature of your business and list all activities 19b If known provide your North American Industry Classification System (NAICS) Code(s) Enter your primary code first To determine your NAICS code go 2 Is this a seasonal business? Yes No If yes first month of season: last month: 20 Does your business (check the yes or no box next to each activity with black or blue pen): 21 Are coin operated amusement machines operated at your business location? Y N 22 Do you improve real property as a contractor? Y N 23 Do you sell gasoline diesel fuel or aviation fuel at posted retail prices? Y N 24 Do you sell prepaid phones phone cards or calling arrangements? Y N 25 Do you sell tires or batteries or rent or lease motor vehicles to others? Y N 26 Do you own or operate a dry cleaning plant or dry drop off facility in Florida? Y N 27 Do you produce or import perchloroethylene? Y N 28 Have you employed or will you employ workers in the state of Florida? ** Y N 29 Is your business already registered and actively paying Florida reemployment tax? Y N 30 Are you reactivating your reemployment tax account? Y N 31 Employment type (check all that apply): 32 On what date did you or will you first employ workers in Florida? ** 33 If your employment type is: 34 Have you paid federal unemployment tax in another state this year or last year? Y N 35 Do you use the services of persons in Florida whom you consider to be self employed independent contractors? Y N 36 Do you lease workers from an employee leasing company? Y N 37 List the locations where you employ workers in Florida 38 If another party (accountant bookkeeper agent) will maintain your payroll provide the following information about the other party: 39 Mailing addresses for reemployment tax All correspondence about your reemployment tax account returns statements rate notices and claims and benefits 3a Legal name of individual owner 3b Owner s telephone number: 3c Legal name of business entity (e g corporation limited liability company partnership trust estate): 4 Trade fictitious or doing business as name: 40 Do you sell communications services; purchase communications services to integrate into prepaid calling arrangements; 41 Are you applying for a direct pay permit for communications services tax? Y N 42 In order to charge the correct amount of tax you must know the taxing jurisdiction in which your customers are located How will you verify the correct 43 If you use multiple databases you may be eligible for both collection allowances If you will file separate returns for each type of database check the box 44 Name and contact information of the managerial representative who can answer questions about filed tax returns: 45 Do you make sales finalized by written financing agreements that are not recorded by the Clerk of the Court 46 Do you own or operate a local electric or natural or manufactured gas (excluding LP gas) utility distribution facility in Florida? Y N 47 Do you extract oil gas sulfur solid minerals phosphate rock or heavy minerals from the soils or waters of Florida? Y N 48 Do you wish to enroll to file and pay taxes fees and surcharges electronically? Y N 49 Contact Person for Electronic Payments 50 Contact Person for Electronic Return Filing Check if same as contact person for electronic payments 51 Choose your filing/payment method: 52 Banking Information (not required for ACH Credit payment method): 53 Enrollee Authorization and Agreement 5a Physical street address of business location or rental property being registered (see instructions): 5b Business telephone number: 5c Fax number: 6 Mail to the attention of: 7 Email address: 8a Business Entity Identification Number Provide the Federal Employer Identification 8b FEIN: 8c SSN*: 9 If you checked Box 1 f because you purchased or acquired an existing business from another person or entity provide the following information about the a Attach check or money order for appropriate registration a Attach required documentation or additional applications if a Bank/financial institution name: a Check the box next to the description that best describes your fuel sales activities a Complete all required sections of this application a copy of Department of Business & Professional a Do you have a written agreement designating a party other than the applicant entity as the operator of the amusement machines at your location? Y N a Do you sell (at retail) new tires for motorized vehicles that are sold separately or as part of a vehicle? Y N a Document number issued by the Florida Secretary of State when the entity was a Indicate your industry category(s) (check all that apply): residential commercial industrial utility bridge/road a Leasing company s name: a Legal name of person or entity: a Mail to: Account Management MS 1 5730 a Make sure that you have provided your FEIN or SSN a Name of person or entity named on certificate of registration: a New business entity (not previously a Reporting Mail Employer s Quarterly Reports certifications and a Sign and date the application about claims and benefits to (check one): ACH Credit is the action taken when the taxpayer s bank transfers a tax payment to the Department s bank account; the Department s account is credited ACH Debit (e check) is the action taken when the Department s bank withdraws a tax payment from the taxpayer s bank account upon the taxpayer s acquisition? Address: Address: Address: Address: Amount enclosed: $ $ 5 fee Sales tax registration for business location or rental property located in Florida and select Privacy Notice for more information regarding the state and federal law governing the collection use or release of SSNs including authorized exceptions another name? applicable Applicant Attestation Declaration and Signature application will be rejected if any part of this section is left blank assignment of customer location to taxing jurisdiction? If you use multiple databases check all that apply If you sell only pay telephone or direct to home authorization; the taxpayer s bank account is debited Authorized Signature Depending on your business structure only the following principal persons may sign this application: b Account type: b Address of person or entity named on certificate of registration: b Date of Florida incorporation formation or organization or date of authorization to conduct business in Florida: b Do you sell (at retail) new or remanufactured lead acid batteries that are sold separately or as a component part of another product b Do you sell products at retail? Y N b FEIN: b New/additional Florida business location b Nonprofit organization B P No Certificate No b Tax Rate Mail tax rate notices and rate related correspondence to b Will books and records be kept at locations in addition to the location provided for item 5? Y N been issued a certificate of registration certificate number or tax account number by the Florida Department of Revenue? Beginning date of business activity at new Florida location: Beginning date of Florida taxable business activity: below See instructions for explanation BUSINESS ACTIVITIES DESCRIPTION BUSINESS BACKGROUND INFORMATION BUSINESS ENTITY INFORMATION BUSINESS STRUCTURE & OWNERSHIP By completing this agreement and submitting this enrollment request the Enrollee applies and is hereby authorized by the Department to file tax returns and reports c Bank account number: c Certificate or tax account number: c Claims Mail notices of benefits paid and other correspondence c DBPR License Number: c Do you purchase materials/supplies from out of state vendors for use in your Florida projects? Y N c Do you rent lease or sell car sharing membership services for the use of motor vehicles that transport fewer than nine passengers? Y N c Domestic employer c Entity s fiscal year ending date (month/day): c New taxable activity at previously c Reemployment tax account number: chartered or authorized to conduct business in Florida: City/State/ZIP: City/State/ZIP: City/State/ZIP: City/State/ZIP: City/State/ZIP: City/State/ZIP: City/State/ZIP: City/State/ZIP: City: City: Coin Operated Amusement Machines consolidated filing number: corporation for purposes of reemployment tax (RT) correspondence related to reporting to (check one): County: County: d Address City State ZIP: d Agricultural (non citrus citrus or crew chief) employer d Bank Routing Number: d Change of Florida county d Do you construct or assemble building components away from your project sites? Y N d Limited Liability Company (check one below) d RT Account Number: Database (Form DR 700012) Date of legal change: Date of location county change: Date of new taxable activity: Date of purchase/acquisition: Department of Revenue taxpayer service center Scan determination letter from the IRS) Document number: Driver license number/Issuing state: Driver license number/Issuing state: e Change of legal entity/business structure e Portion of workforce that is leased: All Part e Sales tax certificate number: Effective 01/15 electronic filing of returns reports and remittances electronically according to this agreement Email address: Email address: Email address: Email address: existing consolidated filing number: f Date of leasing arrangement: f Portion of business acquired: f Purchase/acquisition of existing business Fax number: Federal ID number (FEIN PTIN): Federal PTIN (if tax preparer): fee(s) DO NOT SEND CASH filing of payments through the ACH Credit method First name: FL State agencies provide first six digits of FLAIR Org Florida Administrative Code Florida Business Tax Application For DOR Use Only for tax e Services from another person or entity g Date of purchase or acquisition: General goods in addition to registering for sales and use tax complete and submit a Registration Application for Secondhand Dealers and/or Secondary Metals Recyclers h Was the business operating at the time of purchase/ Have you or will you employ five or more workers for 20 or more weeks within a calendar year? ** Y N Have you or will you employ one or more workers for 20 or more weeks within a calendar year? ** Y N Home address: Home address: http://dor myflorida com/dor/taxes/servicecenters html http://www myfloridacfo com/division/WC/ https://newhire state fl us I certify that I am authorized to sign on behalf of the business entity identified herein and that all information provided in this document has been personally reviewed by i If no on what date did the business close? If services indicate if Administrative Research Other: If services indicate if Administrative Research Other: If yes check the items below that apply and answer question b If no skip to question 47 If yes provide previous name: If yes provide the date you reached or will reach $10 000 gross wages: In addition to any other penalties provided by law including civil penalties I understand it is a criminal offense to: Individual or firm name: information information will be mailed to the address you provided in item 6 If you wish to have these documents mailed elsewhere provide other addresses below into according to the provisions of the Florida Statutes and the Florida Administrative Code It s convenient free Item 20 continues on Page 4 j Did the business have employees at the time of k If yes did you acquire the employees? l Did the acquired entity and your entity share any common ownership management or control at the time of purchase/acquisition? Yes No Last name: liable for penalties and twice the amount of tax under the provisions of s 213 29 F S Link new location to existing located outside the US or its territories please contact us to make other payment arrangements If you are unsure please contact your financial institution Mailing address (if different from # 5a): Mailing address: Mailing address: Mailing address: Mailing address: make tax and fee payments and transmit remittances to the Department electronically This agreement represents the entire understanding of the parties in relation to the me and the facts stated in it are true According to the payment method selected above I hereby authorize the Department to present debit entries into the bank account Middle name/initial: Motor Fuel Sales NAICS Code(s): Name: Name: Name: Name: Name: Note: Due to federal security requirements we cannot process international ACH transactions If any funding for payments comes from financial institutions NOTE: In addition to registering for Reemployment Tax: Note: The person signing the application must be listed under item 12 in the Business Structure & Ownership section Number (FEIN) of the business entity or Social Security Number (SSN)* of the owner/sole Number of employees: Number of employees: number: numbers on your mobile device or go to our website of registration number for each business of Revenue? Old entity s certificate/account number: Old location s certificate/account other person or entity: Page 1 Page 10 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Percent of ownership/control: Percent of ownership/control: Please read the Instructions for Completing the Florida Business Tax Application (Form DR 1N) Every applicant must complete Sections A and K and must answer PM/Delivery Contract Object (MO) postage and time Principal products or services: Principal products or services: Printed name: Printed name: Date: products and services Include all of your taxable activities if known proprietor owner partner officer member or proprietor Sole proprietors employing workers must also have an FEIN purchase/acquisition? purposes R 01/15 R 01/15 R 01/15 R 01/15 R 01/15 read the information provided on this application and that the facts stated in it are true Real Property Contractors referenced above at the depository designated herein (ACH Debit) or I am authorized to register for the ACH Credit payment privilege and accept all responsibility for the Register online at registered business location registered in Florida) Registered location s certificate number registering for sales and use tax complete and submit a Registration Application for Secondhand Dealers and/or Secondary Metals Recyclers (Form DR 1S) Registrant s Responsibilities You must initial next to each responsibility listed below to indicate that you have read acknowledge and understand each one Your Regulation [DBPR] license) RT Acct No Contract Object (other) Rule 12A 1 097 satellite services provide prepaid calling arrangements are a reseller or are applying for a direct pay permit skip to item 44 Second Signature: Title: Date: Section A Reason for Applying and Applicant Information Section B Activities Subject to Sales & Use Tax ($5 fee for in state business/rental locations) Section C Activities Subject to Sales Tax and the Prepaid Wireless E911 Fee Section D Activities Subject to Solid Waste Fees & Surcharge ($30 dry cleaning fee applies) Section E Activities Subject to Reemployment Tax (formerly Unemployment Tax) (no fee) Section F Activities Subject to Communications Services Tax (no fee) Section G Activities Subject to Documentary Stamp Tax (no fee) Section H Activities Subject to Gross Receipts Tax on Electrical Power and Gas (no fee) Section I Activities Subject to Severance Taxes & Miami Dade County Lake Belt Fees (no fee) Section J Enrollment to File and Pay Taxes and Fees Electronically (no fee) Section K Applicant Acknowledgement Declaration and Signature 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 www myflorida com/dor secure and saves paper Signature: Title: Signature: Title: Date: Social Security Number *: Social Security Number*: Telephone number: Telephone number: Telephone number: Telephone number: ( ) Telephone number: ( ) Telephone number: ( ) the QR code to view the list of locations and telephone the questions in bold print at the beginning of every section and subsection This application will be rejected if the required information is not provided The same statute and rule provisions that pertain to all paper documents filed or payments made by the Enrollee also govern an electronic return or payment initiated This is an Agreement between the Florida Department of Revenue hereinafter the Department and the business entity named herein hereinafter the Enrollee entered This is not a credit card payment this registration For detailed information about the e Services program see the instructions (Form DR 1N) or go to www myflorida com/dor and select Enroll Title Title: to www census gov/eos/www/naics Primary Code: trustee 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 USE THIS CHECKLIST TO ENSURE FAST PROCESSING OF YOUR APPLICATION vendors)? whose social security number is provided in items 8c or 12? will have the same filing and paying contacts banking information and method of payment If you wish to enroll each tax/fee/surcharge separately www myflorida com/dor Y N a Sell products or services at retail (to consumers)? Y N b Sell products or services at wholesale (to registered dealers who will sell to consumers)? Y N c Purchase or sell secondhand goods (see description in the Sales and Use Tax section of the instructions Form DR 1N)? If you consign buy or trade secondary Y N d Purchase or sell salvage or scrap metal to be recycled? If you obtain purchase or convert ferrous or nonferrous metals into raw material products in addition to Y N e Sell products or goods from nonpermanent locations (such as flea markets or craft shows)? Y N f Sell products or goods by mail order using catalogs or the Internet? Y N g Rent or lease commercial real property to individuals or businesses? Y N h Rent or lease living or sleeping accommodations to others for periods of six months or less? Y N i Manage the rental or leasing of living or sleeping accommodations belonging to others? Y N j Rent equipment or other property or goods to individuals or businesses? Y N k Repair or alter consumer products or equipment? Y N l Charge admission or membership fees? Y N m Place and operate coin operated amusement machines at business locations belonging to others? Y N n Place and operate food or beverage vending machines at business locations belonging to others? Y N o Place and operate nonfood or nonbeverage vending machines at business locations belonging to others? Y N p Operate vending machines at your business location(s)? Y N q Purchase items that you will include in a finished product assembled or manufactured for sale? Y N r Purchase items for use in your business that were not taxed by the seller when purchased (includes purchases through catalogs the Internet or from out of state Y N s Use dyed diesel fuel for off road purposes? Y N t Provide any of the following services? If yes check the box next to each service you provide Yes No