Form Dr 142 - Solid Mineral Severance Tax Return - 2003
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1
2DR-142
Solid Mineral Severance Tax Return
R. 04/03
Mail to:
Florida Department of Revenue
FEIN:
5050 W. Tennessee Street
Tallahassee, Florida 32399-0150
Taxable Year:
Name and Address:
For RDS validation only - Do not write or stamp in this space.
❑
Check here if amending your return
❑
Check here if you have electronically
transmitted funds (EFT)
A
B
C
Phosphate
Heavy
Other Solid
RETURN DUE BY:
Rock
Minerals
Minerals
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1.
Tons Produced
(from Schedule I, line 2 or Schedule II, line 1)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
2.
Taxable Value of Severed Mineral
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
(from Schedule III, line 4)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
3.
Tax Rate for Taxable Year Indicated at Top of Form
per ton
per ton
of value
4.
Gross Tax Due
$
$
$
(line 3 multiplied by line 1 or 2)
5.
Estimated Payments and Other Credits
First Quarter ............................ $ _________________
Second Quarter ....................... $ _________________
Third Quarter ........................... $ _________________
Fourth Quarter ......................... $ _________________
Other Payments/Credits ......... $ _________________
(see instructions)
TOTAL PAYMENTS AND CREDITS ................................... $
$
$
6.
$
$
$
Tax Due with Return
(line 4 minus line 5) ........................................
7.
Total Tax Due (enter total of line 6, columns A, B, and C)
7. $ ____________________
8.
Penalty and Interest (enter penalty and interest if return is postmarked after April 1)
8a. Delinquency Penalty (10% per month on all tax not paid by
April 1, not to exceed 50% of the amount of tax due for the year)
8a. $ _____________
8b. Interest (floating rate, see instructions)
8b. $ _____________
Total Penalty and Interest (add lines 8a and 8b)
8. $ ____________________
9.
Sales Tax Credit (see instructions)
9. $ ____________________
10. Total Amount Due or
Overpayment
(add lines 7 and 8, minus line 9)
10. $ ____________________
$ ________________________ or
$ ____________________
Overpayment Amount to be
Credited
Refunded
Under penalties of perjury, I declare that I have read the foregoing and the facts stated in it are true.
___________________________________________________________________________________________________
Signature of officer
Title
Phone number
Date
___________________________________________________________________________________________________
Signature of preparer
Address of preparer
Phone number
Date
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