Form Dr-1 - Florida Business Tax Application Page 2
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10DR-1
R. 01/18
Page 2
9. If you checked Box 1.f. because you purchased or acquired an existing business from another person or entity, provide the following information about the
other person or entity:
a. Legal name of person or entity:
b. FEIN:
c. Reemployment tax account number:
d. Address, City, State, ZIP:
e. Sales tax certificate number:
f. Portion of business acquired:
g. Date of purchase or acquisition:
All
Part
Unknown
h. Was the business operating at the time of purchase/
i. If no, on what date did the business close?
Yes
No
acquisition?
j. Did the business have employees at the time of
k. If yes, did you acquire the employees?
Yes
No
Yes
No
purchase/acquisition?
l. Did the acquired entity and your entity share any common ownership, management, or control at the time of purchase/acquisition?
Yes
No
BUSINESS STRUCTURE & OWNERSHIP
10. Check the box next to the structure of your business entity.
d. Limited Liability Company (check one below)
a. Sole proprietorship
e. Business trust
Single member LLC
b. Partnership (check one below)
f. Nonbusiness trust/Fiduciary
Elects treatment as C-corporation **
Married couple
General partnership
g. Estate
Multi-member LLC
Limited partnership
Joint venture
Provide date of death:
c. Corporation (check one below)
Elects treatment as C-corporation **
**Refers to elections made for federal income tax
C-corporation
Not-for-profit corporation
h. Government agency
purposes.
S-corporation
11. Corporations, partnerships, limited liability companies, and trusts must provide the following:
a.
Document number issued by the Florida Secretary of State when the entity was
Document number:
chartered or authorized to conduct business in Florida:
b.
Date of Florida incorporation, formation or organization, or date of authorization to conduct business in Florida:
c.
Entity’s fiscal year ending date (month/day):
12. Identify the owner/sole proprietor, or general partners, officers, managing members, grantors, trustees, or personal representatives of the business entity.
Note: The person signing this application must be listed here.
Name:
Social Security Number *:
Home address:
Percent of ownership/control:
Title:
Driver license number/Issuing state:
City/State/ZIP:
Telephone number:
( )
Name:
Social Security Number*:
Home address:
Percent of ownership/control:
Title:
Driver license number/Issuing state:
City/State/ZIP:
Telephone number:
( )
Name:
Social Security Number *:
Home address:
Percent of ownership/control:
Title
Driver license number/Issuing state:
City/State/ZIP:
Telephone number:
( )
(Attach additional pages, if necessary)
* Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs 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 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 release of SSNs, including authorized exceptions.
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