Form Dr-842 - Seller'S Application For Transferee Liability Certificate - Florida Department Of Revenue

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DR-842
STATE OF FLORIDA
R. 10/95
DEPARTMENT OF REVENUE
TALLAHASSEE, FLORIDA 32399-0100
General Tax Administration
Child Support Enforcement
Property Tax Administration
L. H. Fuchs
Administrative Services
Executive Director
Florida Department of Revenue
Information Services
Seller’s Application for Transferee Liability Certificate
The undersigned, having sold or entered into an agreement to sell a business or stock of goods (as
evidenced by the document attached hereto and made a part hereof), hereby applies for a transferee
liability certificate on behalf of:
(name of selling dealer)
(sales and use tax registration number)
(mailing address of selling dealer)
(FEI number)
(city, state, zip code)
It is requested that the certificate be based on an audit of the selling dealer’s records of transac-
tions during the period that began:
, 19
and ended:
, 19
It is further requested that the certificate be transmitted to:
(name of purchaser)
(mailing address of purchaser)
(city, state, zip code)
Permission is given to include in the certificate information disclosed as a result of the requested
audit which could not, without such permission, be disclosed without violating the confidentiality
requirements of Section 213.053, Florida Statutes.
(signature of owner or representative of selling dealer)
Mail to:
General Tax Administration Program
Compliance Support Process
Post Office Box 5139
Tallahassee FL 32314-5139

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