Form Dr-602g - Governmental Leasehold Intangible Personal Property Tax Application For Extension Of Time To File Return

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DR-602G
R. 01/16
Governmental Leasehold
TC
Intangible Personal Property Tax
Rule 12C-2.0115
Florida Administrative Code
Application for Extension of Time to File Return
Effective 01/16
Taxable year:
Y
Y
Y
Y
Taxpayer should complete Section A and Section C
Federal Employer
Identification Number: _________________________________________________
Section A
(To be completed by taxpayer)
Social Security Number
In order to expedite your request for an extension of time to file your
(if no FEIN): ___________________________________________________________
return, we need your Federal Employer Identification Number (FEIN).
Business Partner #: ____________________________________________________
Contract Object #: ____________________________________________________
Social security numbers are used by the Florida Department of
Revenue as unique identifiers for the administration of Florida’s taxes.
Social security numbers obtained for tax administration purposes are
confidential under sections 213.053 and 119.071, Florida Statutes, and
not subject to disclosure as public records. Collection of your SSN
Name: ____________________________________________________
is authorized under state and federal law. Visit our Internet site at
and select “Privacy Notice” for more information
regarding the state and federal law governing the collection, use, or
Address: __________________________________________________
release of SSNs, including authorized exceptions.
CENTS
US DOLLARS
____________________________________________________
,
,
Tax Due
City: _____________________
State: ________ ZIP: ______________
Check here if you transmitted funds electronically
Section B
(To be completed by the Department of Revenue)
1.
Your application for extension has been denied due to late filing. Your application was
postmarked or signed after the original due date of June 30.
2.
Other (Explanation)
Date
Name and Title
Mail entire application to:
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0100
*** DO NOT DETACH ***
*** DO NOT DETACH ***
Governmental Leasehold
DR-602G
Section C
Intangible Personal Property Tax
(To be completed by taxpayer)
R. 01/16
Application for Extension of Time to File Return
DR-602G
In order to expedite your request for an extension of time to file your
return, we need your Federal Employer Identification Number (FEIN).
Contract Object #
(if available)
Federal Employer
Identification Number
Name
Social Security Number
Address
(if no FEIN)
City/St/ZIP
Y
Y
Y
Y
Taxable year:
US DOLLARS
CENTS
,
,
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this
Tax Due
application, and that to the best of my knowledge and belief the statements herein are true and correct:
Sign here:___________________________________________ Date:__________________
Check here if you transmitted funds electronically
9100 0 99999999 0018015006 5 9999999999 0000 0

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