Form Dr-5 - Application For Consumer'S Certificate Of Exemption
ADVERTISEMENT
1DR-5
Florida Department of Revenue
R. 02/98
Application For Consumer’s Certificate of Exemption
Sales and Use Tax
DO NOT WRITE IN THIS SPACE
Mail To:
For office use only
FLORIDA DEPARTMENT OF REVENUE
CENTRAL REGISTRATION
Cert. #
5050 W TENNESSEE ST
Issue Date
Expires
TALLAHASSEE FL 32399-0100
NO FEE REQUIRED
CHECK ONE: New
Renewal
If renewal, current exemption certificate number: ___________________________________
Organization Name
Street Address
Business Phone
(
)
City/State/ZIP
County
Federal Employer Identification No. (FEIN)
Is Organization Incorporated?
Date of Incorporation
Does org. have IRS exempt status?
Yes
No
Yes
No
Mailing Address (If different than above)
Alternate Phone
(
)
City/State/ZIP
County
Does the organization receive income from the sale or lease of tangible personal property, the lease of real property or the sale of taxable services? Yes
No
If yes, provide the organization’s sales tax registration number:
ALL DOCUMENTS WILL BE RETAINED AS PART OF YOUR APPLICATION
Florida Statute exemption category for which you are applying (check only one)
Home for the Aged, Nursing Home or
Athletic Event Sponsor - 212.08(7)(gg)
Environmental Citizen Support
Hospice - 212.08(7)(m)
Charitable Institution - 212.08(7)(o)2b
Organization - 212.08(7)(kk)
Military Museum Fundraiser -
Coast Guard Auxiliary - 212.08(7)(cc)
Veterans Organization - 212.08(7)(o)2e
212.08(7)(l)
Community Cemetery - 212.08(7)(bb)
Volunteer Fire Department - 212.08(7)(u)
Organization Benefitting Minors -
Credit Union - 213.12
Other____________________
212.08(7)(n)
Educational Institution - 212.08(7)(o)2d
(Provide Statutory Citation)
Religious Institution - 212.08(7)(o)2a
Fair Association - 212.08(7)(jj)
Scientific Organization - 212.08(7)(o)2c
Governmental Agency - 212.08(6)
Certification
I hereby attest that a Consumer’s Certificate of Exemption, if granted, will be extended in lieu of sales and use tax only on
the purchase or lease of items directly used or consumed in carrying on the customary non-profit activities of this applicant.
I declare that I have read the foregoing application, including attached documentation, and that the facts stated in it are
true.
Signature
Print Name of Signator
Title
Date
For more information, contact Central Registration at 1-800-352-3671 (in Florida only) or
850-487-4130, Monday - Friday, 8 a.m. to 5 p.m., ET.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial