Application For Florida Enterprise Zone Jobs Credit For Sales Tax printable pdf download

DR-15ZC

Application for Florida Enterprise Zone Jobs Credit for Sales Tax

R. 10/09

Rule 12A-1.097

Florida Administrative Code

Effective 06/10

Business Name _________________________________________________________________________________________________________________

Owner Name ___________________________________________________________________________________________________________________

Mailing Address _ ________________________________________________________________________________________________________________

City ____________________________________________________State _______________________________ ZIP ______________________________

Business Location _ ______________________________________________________________________________________________________________

City ____________________________________________________State _______________________________ ZIP ______________________________

–

Business Federal Employer I.D. #

–

Sales Tax Certificate #

Enterprise zone identification number assigned per section (s.) 290.0065, Florida Statutes (F.S.) in which above

business is located ....................................................................................................................................................................EZ

Is this zone designated as a rural enterprise zone, per s. 290.004(8) F.S.? . ................................................................................❑ YES

❑ NO

If yes, complete Schedule Two attached. If no, complete Schedule One attached.

9a.

Is each employee (person) listed on Schedule One or Two a permanent full-time employee hired to perform

duties in connection with the operations of the business for an average of at least 36 hours per week? ..................................❑ YES

❑ NO

9b.

Is each employee (person) listed on Schedule One or Two a permanent full-time employee leased from an employee

leasing company licensed under Chapter 468, F.S. and have they been continuously leased to the employer for an

average of at least 36 hours per week for more than six months to perform duties in connection with the operations of

the business for an average of at least 36 hours per week each month throughout the year? ...................................................❑ YES

❑ NO

10.

Is this a “small business” as defined in s. 288.703(1), F.S.? . ........................................................................................................❑ YES

❑ NO

11.

Are the new employees, for which the credit is claimed, participants in the Welfare Transition

Program (WTP)? If yes, complete Schedule Three attached. . .....................................................................................................❑ YES

❑ NO

12.

Computation of the increase in permanent full-time jobs over the 12 months prior to the date of application:

Enter the number of permanent full-time jobs on the date of application:

_________________________

Enter the number of permanent full-time jobs on the date 12 months prior to the date of the application:

_________________________

Subtract the amount on line 12b from the amount on line 12a and enter the result:

_________________________

This application is due to the Department of Revenue within six months of the date of hire for the new employee(s) or within seven months of

the date of hire for leased employee(s). Your application will be denied if not filed on time. Any person who fraudulently claims the credit is liable for

repayment of the credit plus a mandatory penalty of 100 percent plus interest. After certification of this application by the appropriate enterprise zone

coordinator, mail the completed application to:

RETURN RECONCILIATION, FLORIDA DEPARTMENT OF REVENUE, 5050 WEST TENNESSEE ST, TALLAHASSEE FL 32399-0129.

NOTE: Your job credit(s) will expire 24 months after approval, provided the employee(s) remains employed for 24 months.

I hereby affirm under penalty of perjury that all statements on this document are true and correct to the best of my knowledge and belief.

Signature of owner, officer, or partner

Printed name

Date

Enterprise Zone Coordinator Certification Section

Signature of Enterprise Zone Coordinator

Printed name

Date

Enterprise Zone Coordinator: Mail a copy of the completed application to the address above.