Form DR-700012 Fillable Application for Certification of Communications Services Database R.10/13
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Application for certification of database Application for recertification of database Be a comma delimited ( csv) file Be organized by individual customer address records (not by Be standardized using United States Postal Service addressing Both provider and vendor (Check if the database is used both Check one: Contain commas as field separators Contain only Florida service addresses as defined by Contains records for states other than Florida Data file is uploaded with this application Data file will be submitted through alternative means (Please contact the Local Government Unit for assistance in submitting Does not contain record headers Have only one record per row Include a sequential counter (starting from 1) for each record Include all service address records for the entire geographic Is an invalid file type Not exceed a maximum record length of 172 characters Provide mail city name (the name of the post office that Provider of communications services Records are not provided in the required layout s 202 11(14) F S Vendor (See Special Instructions for Vendors on page 3 ) 1 ABC Phone Co 1801 ROSE MALLOW LN 12 127 002404197 229 ABC Communications 1200 E GILFORD DAVIS RD 3 300 BRAUGHTON ST SE 4 digit ( +4) part of ZIP code 5 digit ZIP code a material change please see Rule 12A 19 072(6) F A C accuracy rate of 95 percent at a 95 percent level of confidence as Address Address Files for Certification Testing Address if different from above address in the city of Daytona Beach should be displayed as address range) address records where your assignment of taxing jurisdictions address) Alpha Alpha Alpha Alpha/Numeric Alpha/Numeric Applicant must designate a contact person responsible for providing access to all records facilities and processes that the Department determines are reasonably Application complete Application for Certification of Applications may be submitted online using the Department of Revenue s PointMatch system located at: approval notice At the end of the certification period you area covered by the database being tested BRANFORD FL 32008 12 121 002405314 Business Address Business Mailing Address if different from above Business Name Business Partner Number Certification is contingent upon there being no material changes Certification is valid for three years following the date of the Certification Period and Recertification Certification Report CHARACTERS City State ZIP COMMENTS Communications Services Database County FIPS code county FIPS code Each jurisdiction has a unique 9 digit GNIS County should be displayed as 12 127 000000000 An COUNTYID CST Database Certification days after receipt notify you of any errors or omissions Access denial inform you of any remedy that is available and indicate Department s Address/Jurisdiction Database determined through a statistically reliable sample The accuracy DOR Use Only DR 700012 DR 700012 each jurisdiction Effective 01/14 Enter your Federal Employer Identification Number (FEIN) Examples of the record layout are provided below: Examples: An address in the unincorporated area of Volusia Fax Number E Mail Address FEATID Feature ID code Applicants must supply the Feature ID code for Feature ID code For unincorporated areas zeros are used as the Federal Employer FIELD FIELD NAME FIPS 55 data identifies the state and county codes The 2 digit FIPS code for Florida is 12 Each county has a unique 3 digit Florida Administrative Code Florida Department of Revenue For applicant s use to identify address records For assistance completing your Application for Certification or For Further Assistance Form DR 700014 Not applicable for vendors GLEN ST MARY FL 32040 4604 12 003 000000000 GNIS place feature ID; Use zeros for unincorporated area Government Unit and request a determination regarding whether a House number https://pointmatch state fl us Identification Number If there are such changes contact the Department s Local information concerning your database Instructions for Preparing and Submitting Customer internally and offered to other providers as part of a service ) Local Government Unit Local govt unit@dor state fl us Mail application to: mail or e mail If denied the notice will specify the grounds for MAILCITY Mailing city name matched (or mismatched) the information contained in the MAXIMUM must be measured based on the entire geographic area within the must submit an Application for Certification of Communications Name (please print) Title Name of Contact Person (please print) Telephone Number Names Information System (GNIS) Feature Identifiers (ID) The necessary to review and make a determination regarding this application new Form DR 700012 is needed For examples of what constitutes NUMBER Numeric Numeric Numeric Numeric of a database we will examine the application and within 90 or denied within 180 days after receipt of a completed application or post office boxes to the proper jurisdiction with an overall ORANGE PARK FL 32003 7067 12 019 000000000 Our certification system uses both the Federal Information Page 2 Page 3 Please complete page 1 We will contact you with further Please Read Instructions First PO Box 6530 Post directional POSTDIR Pre directional PREDIR Processing Standards (FIPS) 55 codes and the Geographic Providers must enter this number It is on the Certificate of Registration R 10/13 R 10/13 Reasons for Rejection of Your File Received by LGU recertification Databases submitted for recertification prior to RECNUM Record Header Information Records within the address data file must: Report and Certification Error Report will be included REQUIRED Required Address Data File Layout REQUIREMENTS Rule 12A 19 100 Sample Record Layout Section A Business Information Section B Contact Person Section C Authorized Signature Section D Database Method of Submission ( Check one) This section not applicable for vendors Sequence counter (e g 1) Services Database Form DR 700012 and database for Signature Date Signature of person authorized to request certification on behalf of applicant Special Instructions for Vendors standards STATE state covered by the database State FIPS code; always 12 for Florida State name abbreviated; always FL for Florida STATEFIPS STNAME Street name Street suffix STSUFFIX submitting your data file please contact the Local Government supports the mail delivery area covered by that customer Tallahassee FL 32314 6530 Testing Accuracy Standard The address data file must: The Certification Report will provide statistics on the number of the expiration of the certification period will be treated as certified the procedure that must be followed A copy of the Certification To pass certification your database must assign street addresses to records facilities and processes must be provided within 10 to the database or procedures for its updating and maintenance Turnaround Time Unit at 850 717 6630 or by e mailing at: Unit number Unit type UNITNUM UNITTYPE Upon receipt of an application for certification or recertification Use of FIPS 55 Codes and GNIS Feature ID Codes USERFIELD We will notify you of the certification test results online or by while the application for recertification is pending working days after notification An application must be approved your file ) ZIP+4