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Get and Sign F 7004 Form 2017
D Y Y
FILING STATUS
(Mark “X” in
one box only)
US DOLLARS
CENTS
Tentative tax due
Check here if you transmitted
funds electronically
Sign here:___________________________________________ Date:__________________
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135
▼
(See reverse side)
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
application, and that to the best of...
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