Florida Application 2018-2019

Florida Business Tax Application

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 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.

Section A – Reason for Applying and Applicant Information

1. Indicate your reason for submitting this application (check only one; provide date and certificate number, if applicable).

a. New business entity (not previously registered in Florida). Beginning date of Florida taxable business activity:

b. New/additional Florida business location. Beginning date of business activity at new Florida location: Link new location to existing consolidated filing number:

c. New taxable activity at previously registered business location. Date of new taxable activity: Registered location’s certificate number:

d. Change of Florida county. Date of location county change: Old location’s certificate/account number: Link new county location to existing consolidated filing number:

e. Change of legal entity/business structure. Date of legal change: Old entity’s certificate/account number:

f. Purchase/acquisition of existing business from another person or entity. Date of purchase/acquisition:

2. Is this a seasonal business? Yes No If yes, first month of season: last month:

BUSINESS ENTITY INFORMATION

3a. Legal name of individual owner (for sole proprietor only): Last name: First name: Middle name/initial: 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:

5a. Physical street address of business location or rental property being registered (see instructions):

City/State/ZIP: County: 5b. Business telephone number:

5c. Fax number:

6. Mail to the attention of: Mailing address (if different from # 5a):

City/State/ZIP:

7. Email address:

8a. Business Entity Identification Number - Provide the Federal Employer Identification Number (FEIN) of the business entity or Social Security Number (SSN) of the owner/sole proprietor.

8b. FEIN: 8c. SSN:

Section B – Activities Subject to Sales & Use Tax

9. If you checked Box 1.f., provide information about the other person or entity.

a. Legal name of person or entity: b. FEIN: c. Reemployment tax account number:

d. Address, City, State, ZIP: e. Sales tax certificate number:

f. Portion of business acquired: All Part Unknown g. Date of purchase or acquisition:

h. Was the business operating at the time of purchase/acquisition? Yes No i. If no, on what date did the business close?

j. Did the business have employees at the time of purchase/acquisition? Yes No k. If yes, did you acquire the employees? Yes No

l. Did the acquired entity and your entity share any common ownership, management, or control at the time of purchase/acquisition? Yes No

10. Check the box next to the structure of your business entity.

a. Sole proprietorship

b. Partnership (check one below) Married couple General partnership Limited partnership Joint venture

c. Corporation (check one below) C-corporation Not-for-profit corporation S-corporation

d. Limited Liability Company (check one below) Single member LLC Elects treatment as C-corporation Multi-member LLC Elects treatment as C-corporation

e. Business trust f. Nonbusiness trust/Fiduciary g. Estate Provide date of death: h. Government agency

11. Corporations, partnerships, limited liability companies, and trusts must provide the following:

a. Document number issued by the Florida Secretary of State when the entity was chartered or authorized to conduct business in Florida:

b. Date of Florida incorporation, formation or organization, or date of authorization to conduct business in Florida:

c. Entity’s fiscal year ending date (month/day):

12. Identify the owner/sole proprietor, or general partners, officers, managing members, grantors, trustees, or personal representatives of the business entity.

Note: The person signing this application must be listed here.

Name: Social Security Number: Home address: Percent of ownership/control:

Title: Driver license number/Issuing state: City/State/ZIP: Telephone number:

Name: Social Security Number: Home address: Percent of ownership/control:

Title: Driver license number/Issuing state: City/State/ZIP: Telephone number:

Name: Social Security Number: Home address: Percent of ownership/control:

Title: Driver license number/Issuing state: City/State/ZIP: Telephone number:

Section C – Business Background Information

13. Has this business entity ever been known by another name? Yes No If yes, provide previous name:

14. Has this business entity ever been issued a certificate of registration, certificate number or tax account number by the Florida Department of Revenue? Yes No

15. Has any owner/proprietor, partner, officer, member, trustee, or the person whose social security number is provided in items 8c or 12 ever been issued a certificate of registration, certificate number or tax account number by the Florida Department of Revenue? Yes No

16. If you answered “Yes” to questions 14 or 15, provide the name, address and certificate of registration number for each business, proprietor, owner, partner, officer, member or trustee.

a. Name of person or entity named on certificate of registration:

b. Address of person or entity named on certificate of registration:

c. Certificate or tax account number:

17. Has a tax warrant ever been filed by the Florida Department of Revenue against this business entity? Yes No

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 whose social security number is provided in items 8c or 12? Yes No

Section D – Business Activities Description

19a. Describe the primary nature of your business and list all activities, products, and services. Include all of your taxable activities if known.

19b. If known, provide your North American Industry Classification System (NAICS) Code(s). Enter your primary code first.

Primary Code:

20. Does your business (check the yes or no box next to each activity with black or blue pen):

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?

Y N d. Purchase or sell salvage or scrap metal to be recycled?

Y N e. Sell products or goods from nonpermanent locations?

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?

Section E – Activities Subject to Reemployment Tax (formerly Unemployment Tax)

26. Do you own or operate a dry-cleaning plant or dry drop-off facility in Florida? Yes No

27. Do you produce or import perchloroethylene? Yes No

28. Have you employed or will you employ workers in the state of Florida? Yes No

29. Is your business already registered and actively paying Florida reemployment tax? Yes No RT Account Number:

30. Are you reactivating your reemployment tax account? Yes No RT Account Number:

31. Employment type (check all that apply):

Regular employer

Domestic employer (household & personal care)

Indian tribe or Tribal unit

Nonprofit organization

Governmental entity

Agricultural (noncitrus) employer

Agricultural (citrus) employer

Agricultural crew chief

FL State agencies provide first six digits of FLAIR Org Code

32. On what date did you, or will you first employ workers in Florida?

33. If your employment type is:

a. Regular, Indian tribe/Tribal unit, or Governmental employer

Have you or will you pay gross wages of at least $1,500 within a calendar quarter? Yes No If yes, provide the date you reached or will reach $1,500 gross wages:

Have you or will you employ one or more workers for 20 or more weeks within a calendar year? Yes No If yes, provide the date of the 20th week:

b. Nonprofit organization

Have you or will you employ four or more workers for 20 or more weeks within a calendar year? Yes No If yes, provide the date of the 20th week:

c. Domestic employer

Have you or will you pay gross wages of at least $1,000 within a calendar quarter? Yes No If yes, provide the date you reached or will reach $1,000 gross wages:

d. Agricultural (non-citrus, citrus, or crew chief) employer

Have you or will you pay gross wages of at least $10,000 within a calendar quarter? Yes No

Have you or will you employ five or more workers for 20 or more weeks within a calendar year? Yes No If yes, provide the date of the 20th week:

34. Have you paid federal unemployment tax in another state this year or last year? Yes No If yes, in which state: in which year:

35. Do you use the services of persons in Florida whom you consider to be self-employed, independent contractors? Yes No

36. Do you lease workers from an employee leasing company? Yes No

a. Leasing company’s name:

b. FEIN: c. DBPR License Number: d. RT Account Number:

e. Portion of workforce that is leased: All Part f. Date of leasing arrangement:

37. List the locations where you employ workers in Florida.

Address: City: County: Number of employees:

Principal products or services: If services, indicate if Administrative Research Other

Address: City: County: Number of employees:

Principal products or services: If services, indicate if Administrative Research Other

Address: City: County: Number of employees:

Principal products or services: If services, indicate if Administrative Research Other

38. If another party (accountant, bookkeeper, agent) will maintain your payroll, provide the following information about the other party:

Individual or firm name: Federal ID number (FEIN, PTIN):

Mailing address: City/State/ZIP:

Email address: Telephone number:

39. Mailing addresses for reemployment tax.

Payroll address (item 38) Other, below

a. Reporting – Name: Telephone number:

Mailing address: City/State/ZIP:

Email address:

Payroll address (item 38) Other, below

b. Tax Rate – Name: Telephone number:

Mailing address: City/State/ZIP:

Email address:

c. Claims – Mail notices of benefits paid and other correspondence about claims and benefits to (check one): Payroll address (item 38) Other, below

Name: Telephone number:

Mailing address: City/State/ZIP:

Email address:

Section F – Activities Subject to Communications Services Tax

40. Do you sell communications services; purchase communications services to integrate into prepaid calling arrangements; or are you applying for a direct pay permit for communications services tax? Yes No

Telephone service (local, long distance, wireless or VOIP)

Paging service

Facsimile (fax) service

Reseller (only sales for resale; no sales to retail customers)

Video service

Direct-to-home satellite service

Pay telephone service

Purchase services to integrate into prepaid calling arrangements

Other services; please describe:

41. Are you applying for a direct pay permit for communications services tax? Yes No

42. How will you verify the correct assignment of customer location to taxing jurisdiction? Check all that apply.

1. An electronic database provided by the Department.

2. Your own database that will be certified by the Department.

3. A database supplied by a vendor. Vendor: Product:

4. ZIP+4 and a methodology for assignment when ZIP codes overlap jurisdictions.

5. ZIP+4 that does not overlap jurisdictions.

6. None of the above.

43. If you use multiple databases, check the box below. I will file two separate communications services tax returns, one for each type of database.

44. Name and contact information of the managerial representative who can answer questions about filed tax returns:

Name: Telephone number:

Mailing address: City/State/ZIP:

Email address:

45. Do you make sales, finalized by written financing agreements, that are not recorded by the Clerk of the Court, but do require documentary stamp tax to be paid? Yes No

a. Do you anticipate five or more transactions subject to documentary stamp tax per month? Yes No

Section G – Activities Subject to Documentary Stamp Tax

46. Will books and records be kept at locations in addition to the location provided for item 5? Yes No

If yes, provide location information:

Address: City/State/ZIP:

Address: City/State/ZIP:

Address: City/State/ZIP:

Address: City/State/ZIP:

Section H – Activities Subject to Gross Receipts Tax on Electrical Power and Gas

46. Do you own or operate a local electric or natural or manufactured gas (excluding LP gas) utility distribution facility in Florida? Yes No

Electricity Natural or manufactured gas

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? Yes No

Section I – Activities Subject to Severance Taxes & Miami-Dade County Lake Belt Fees

47. Do you extract oil, gas, sulfur, solid minerals, phosphate rock or heavy minerals from the soils or waters of Florida? Yes No

a. Extracting oil for sale, transport, storage, profit, or commercial use.

b. Extracting gas for sale, transport, profit, or commercial use.

c. Extracting sulfur for sale, transport, storage, profit, or commercial use.

d. Extracting solid minerals, phosphate rock, or heavy minerals from the soil or water for commercial use.

e. Extracting lime rock or sand from within the Miami-Dade County Lake Belt Area.

Section J – Enrollment to File and Pay Taxes and Fees Electronically

48. Do you wish to enroll to file and pay taxes, fees, and surcharges electronically? Yes No

49. Contact Person for Electronic Payments

Name: Telephone number: Fax number:

Mailing address: City/State/ZIP:

Email address:

a company employee a non-related tax preparer the party named in item 38 Federal PTIN (if tax preparer):

50. Contact Person for Electronic Return Filing Check if same as contact person for electronic payments.

Name: Telephone number: Fax number:

Mailing address: City/State/ZIP:

Email address:

a company employee a non-related tax preparer the party named in item 38 Federal PTIN (if tax preparer):

51. Choose your filing/payment method:

File Electronically Pay Electronically (select one): ACH-Debit (e-check) ACH-Credit

52. Banking Information (not required for ACH-Credit payment method):

a. Bank/financial institution name: b. Account type: Business Personal Checking Savings

c. Bank account number: d. Bank Routing Number:

53. Enrollee Authorization and Agreement

This is an Agreement between the Florida Department of Revenue and the business entity named herein. By completing this agreement and submitting this enrollment request, the Enrollee authorizes electronic filing and payments according to the selected method.

Registrant’s Responsibilities

I understand it is my responsibility to notify the Department of Revenue of any changes of business structure, activities, location, mailing address or contact information.

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 liable for penalties and twice the amount of tax.

Fail or refuse to register.

Not timely file a tax return or report.

Underreport a tax, surcharge or fee liability on a return or report filed.

Fail or refuse to collect a required tax, surcharge or fee.

Not remit a collected tax, surcharge or fee.

Make a worthless check, draft, debit card payment, or electronic funds transfer to the Department.

Section K – Applicant Acknowledgement, Declaration and Signature

Authorized Signature – Depending on your business structure, only the following principal persons may sign this application.

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.

Checklist

Complete all required sections of this application.

Make sure that you have provided your FEIN or SSN.

Sign and date the application.

Attach required documentation or additional applications, if applicable.

Mail to: Account Management MS 1-5730, Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0160