Form Dr-15cs - Sales And Use Tax Return 2001 Page 2

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DUE DATE OF RETURN — Your return and payment are due on the 1st and late after the 20th day of the month following each collection period. If
the 20th falls on a Saturday, Sunday, or state or federal holiday, your return must be postmarked or hand delivered on the first business day following the
20th. You must file a return even if no tax is due.
SIGNATURE REQUIREMENT — Sign and date your DR-15 return. For corporations, the authorized corporate officer must sign. If someone else
prepared the return, the preparer also must sign and date the return in the space provided.
Fraud Penalties
FRAUDULENT CLAIM OF EXEMPTION; PENALTIES — Section 212.085, Florida Statutes (F.S.), provides that when any person fraudulently, for the
purpose of evading tax, issues to a vendor or to any agent of the state a certificate or statement in writing in which he or she claims exemption from sales
tax, such person, in addition to being liable for payment of the tax plus a mandatory penalty of 200% of the tax, shall be liable for fine and punishment as
provided by law for a conviction of a felony of third degree, as provided in s. 775.082, s. 775.083, or s. 775.084, F.S.
SPECIFIC FRAUD PENALTY — Any person who makes a false or fraudulent return with a willful intent to evade payment of any tax or fee imposed
under Ch. 212, F.S., in addition to the other penalties provided by law, will be liable for a specific penalty of 100% of the tax bill or fee and, upon
conviction, for fine and punishment as provided in s. 775.082, s. 775.083, or s. 775.084, F.S.
FAILURE TO COLLECT AND PAY OVER TAX OR AN ATTEMPT TO EVADE OR DEFEAT TAX — Any person who is required to collect, truthfully
account for, and pay over any tax enumerated in Ch. 201, Ch. 206, or Ch. 212, F.S., and who willfully fails to collect such tax or truthfully account for and
pay over such tax or willfully attempts in any manner to evade or defeat such tax or the payment thereof; or any officer or director of a corporation who
has administrative control over the collection and payment of such tax and who willfully directs any employee of the corporation to fail to collect or pay
over, evade, defeat, or truthfully account for such tax will, in addition to other penalties provided by law, be liable to a penalty equal to twice the total
amount of the tax evaded or not accounted for or paid over, as provided in s. 213.29, F.S.
I hereby certify that this return has been examined by me and to the best of my knowledge and belief is a true and complete return.
Signature of Taxpayer
Date
Signature of Preparer
Date
15(a). Exempt Amount of Items Over $5,000 _________________________________
Discretionary Sales Surtax
15(b). Other Amounts in Column 3 NOT Subject to Surtax _______________________
At .25% Rate
At .5% Rate
At .75% Rate
At 1.0% Rate
At 1.25% Rate
At 1.5% Rate
16.
Taxable Sales/Purchases Subject to Surtax
17.
Surtax Amounts Collected
Enterprise Zone Number ______________________________
18(a). Eligible Employees’ Wages x 5% =
18(b). Eligible WTP Participants’ Wages x 15% =
18(c). Eligible Employees’ Wages x 15% =
18(d). Eligible Employees’ Wages x 10% =
19(a). Total of Lines 18(a) through 18(d)
19(b). Enterprise Zone Lawful Deductions
20.
Total of Lines 19(a) and 19(b) [Also enter this total on Line 6 on front of coupon] ........................................................................... 20.
21.
Taxable Sales/Purchases/Rentals of Farm Equipment — 2.5% Rate (included in Line A) ............................................................. 21.
22.
Taxable Sales/Purchases of Commercial Telecommunications/Electric Power or Energy — 7% Rate (included in Line A) ..... 22.
23.
Taxable Sales/Purchases of Diesel Fuel — 6% Rate (included in Line A) ...................................................................................... 23.
24(a). Number of Amusement Machines
24(b). Taxable Sales from Amusement Machines (included in Line A)
I hereby certify that this return has been examined by me and to the best of my knowledge and belief is a true and complete return.
Signature of Taxpayer
Date
Signature of Preparer
Date
15(a). Exempt Amount of Items Over $5,000 _________________________________
Discretionary Sales Surtax
15(b). Other Amounts in Column 3 NOT Subject to Surtax _______________________
At .25% Rate
At .5% Rate
At .75% Rate
At 1.0% Rate
At 1.25% Rate
At 1.5% Rate
16.
Taxable Sales/Purchases Subject to Surtax
17.
Surtax Amounts Collected
Enterprise Zone Number ______________________________
18(a). Eligible Employees’ Wages x 5% =
18(b). Eligible WTP Participants’ Wages x 15% =
18(c). Eligible Employees’ Wages x 15% =
18(d). Eligible Employees’ Wages x 10% =
19(a). Total of Lines 18(a) through 18(d)
19(b). Enterprise Zone Lawful Deductions
20.
Total of Lines 19(a) and 19(b) [Also enter this total on Line 6 on front of coupon] ........................................................................... 20.
21.
Taxable Sales/Purchases/Rentals of Farm Equipment — 2.5% Rate (included in Line A) ............................................................. 21.
22.
Taxable Sales/Purchases of Commercial Telecommunications/Electric Power or Energy — 7% Rate (included in Line A) ..... 22.
23.
Taxable Sales/Purchases of Diesel Fuel — 6% Rate (included in Line A) ...................................................................................... 23.
24(a). Number of Amusement Machines
24(b). Taxable Sales from Amusement Machines (included in Line A)

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