Form Dr-841 - Request For Copy Of Tax Return July 2015
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2DR-841
R. 07/15
Rule 12-22.005
Request for Copy of Tax Return
Florida Administrative Code
Effective 07/15
This form is used to request a copy of any tax return filed with the Florida Department of Revenue.
Section 1: Taxpayer Information
Taxpayer Name:
Florida Tax Registration Number:
Federal Employers Identification Number (FEIN):
Social Security Number (SSN)*:
Street or Mailing Address:
City:
State:
ZIP:
Email Address:
Telephone Number:
Fax Number:
Section 2: Taxpayer Representative
This section is to be completed when a taxpayer representative will be receiving the records
-
requested. A signed Power of Attorney and Declaration of Representative (Form DR-835) must be attached.
Representative Name:
Street or Mailing Address:
City:
ZIP:
State:
Email Address:
Fax Number:
Telephone Number:
Section 3: Return(s) Requested
Tax Return Type: (select all that apply)
Amusement Machine Certificate Fee
From:
To:
From:
To:
Communications Services Tax
Corporate Income Tax
From:
To:
To:
Documentary Stamp Tax
From:
Estate Tax
Date of Death:
Decedent's SSN*:
Florida Business Tax Application
To:
From:
From:
To:
Fuel Tax
To:
From:
Government Leasehold (Intangible) Tax
From:
To:
Gross Receipts Tax on Dry Cleaning
From:
To:
Gross Receipts Tax on Utility Services
Insurance Premium Taxes and Fees
From:
To:
Miami-Dade Lake Belt Mitigation Fees
From:
To:
From:
To:
Motor Vehicle Warranty Fee
To:
From:
Oil Production Tax
From:
To:
Pollutants Tax
Reemployment Tax (formerly Unemployment Tax)
From:
To:
Rental Car Surcharge
From:
To:
Sales and Use Tax
From:
To:
Solid Minerals Severance Tax
From:
To:
From:
To:
Solid Waste Fees (Tires/Batteries)
Additional Information on Return(s) Requested:
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Parent category: Financial