DR-1214
Application for Temporary
R. 01/16
Tax Exemption Permit
Rule 12A-1.097
Florida Administrative Code
Effective 01/16
SECTION I
This application is to be completed for each project for which exemption from Florida sales and/or use tax is claimed pursuant to
section 212.08(5)(b), Florida Statutes, and Rule 12A-1.096, Florida Administrative Code. See reverse side for mailing adress.
EXEMPTION CLAIMED AS:
New Business
Expanding Business
Spaceport Activity
Mining Activity
1.
(a) Business Name: _________________________________________________________________________________________________
(b) Mailing Address: ________________________________________________________________________________________________
City, State, ZIP: _________________________________________________________________________________________________
(c) Website address: ________________________________________________________________________________________________
(d) Florida Sales Tax Number for location listed in (2)(a) (required): ________________________________________________________
(e) FEIN: __________________________________________________________________________________________________________
(f) Telephone Number: ( ________ ) _________________________ Fax Number:( ________ ) __________________________________
(g) Name, address, position, and telephone number of person or persons to be contacted regarding this project. (Form DR-835,
Power of Attorney, must be submitted if not an officer or employee of the business.)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
2.
(a) Project Location (Address where the machinery and equipment will be or has been installed):
________________________________________________________________________________________________________________
(b) Did you purchase or buy out another business at the location in 2.(a)?
Yes
No
If yes, when?_____________________
(c) Project Description (Explain in full detail the purpose and scope of work to be accomplished by the project.):
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
(Attach additional sheet, if necessary)
(d) Is any qualifying machinery and equipment going to be leased?
Yes
No
If yes, will this be a:
Capital Lease
Operating Lease Please provide a complete, legible copy of the lease (If available).
(e) List the types of the major machinery and equipment that may be purchased or leased for the project. (DO NOT file a
separate application for each item of machinery and equipment to be purchased, if they are for the same project.)
______________________________________________________
_____________________________________________________
______________________________________________________
_____________________________________________________
______________________________________________________
_____________________________________________________
(Attach additional sheet, if necessary)
(f) Total cost of the machinery and equipment to be purchased or leased for the project: __________________________________
(g) Total cost of the entire project: ____________________________________________________________________________________
3.
(a) What is the product or item that will be made for sale by the machinery and equipment listed at the project location?
________________________________________________________________________________________________________________
(b) Is this product or a similar product already being made at the project location in 2.(a)?
Yes
No
(c) Is this product or a similar product already being made at another Florida location of this company?
Yes
No If yes,
provide the location or locations: __________________________________________________________________________________
(d) Will production of the product in 3.(a) be closed down at a location listed in 3.(c), or has production been closed down?
Yes
No If yes, when will or did production at that location stop? ______________________________________________
(e) What type of businesses or customers will be purchasing the product in 3.(a)? _________________________________________
_______________________________________________________________________________________________________________