DR-29
Florida Sales and Use Tax
R. 01/16
Application for Release or Refund of Security
Rule 12A-1.097
Florida Administrative Code
Effective 01/16
SECURITY INFORMATION:
Type of Security Posted (Check only one.)
q Cash Deposit or Cash Bond
q Surety Bond
q Irrevocable Letter of Credit
Date Security Posted
Amount of Security
Certificate No.
Federal Employer Identification Number
Name of Certificate Holder
Mailing Address
City
County
State
ZIP Code
RELEASE OR REFUND JUSTIFICATION:
Check all that apply:
q I have complied with the provisions of Chapter 212, F.S., for a period of twelve consecutive months, beginning
_________________________ and ending _________________________.
q I have complied with the terms and conditions of the compliance agreement entered into with the Department on
this date: ____________________________.
q I have ceased business operations as of this date: ____________________________.
FOR BUSINESSES THAT CEASE OPERATIONS:
•
A final return with applicable tax payment must accompany this application.
•
Your original Certificate of Registration and Florida Annual Resale Certificate must be surrendered with this
application.
•
Your certificates will be cancelled as of the date entered above.
APPLICANT CERTIFICATION:
Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I
understand that if I later resume business activities requiring registration with the Department of Revenue, I may be
required to post similar security as a condition of obtaining a certificate of registration.
________________________________________________________________________
_________________________
Signature of Owner(s), Partner, Corporate Officer or Member
Date
DEPARTMENT VERIFICATION:
q Release or refund entire amount of security.
q Apply $ _____________________________ to Certificate No. __________________________ Period: _______________
For the Department: _________________________________________________________________ Date: _______________