Free DR-18 - Florida

Application for Amusement Machine Certificate

DR-18 R. 03/06

General Information and Instructions
A COIN-OPERATED AMUSEMENT MACHINE is any machine operated by coin, slug, token, coupon, or similar device for the purpose of entertainment or amusement. Amusement machines include but are not limited to: coin-operated radio and televisions, telescopes, pinball machines, music machines, juke boxes, mechanical rides, video games, and all other similar amusement devices. CERTIFICATE REQUIRED TO BE DISPLAYED. Any sales tax dealer that is registered or is required to be registered, who is an "operator" of coin-operated amusement machines which are operated in Florida, must apply for a certificate. Every physical location where coin-operated amusement machines are in operation must display a certificate authorizing the operation of a specified number of machines. OPERATOR IS REQUIRED TO PURCHASE CERTIFICATE Business Proprietor - The business proprietor shall be deemed to be the lessee and operator of the machines, unless otherwise provided in a written agreement between the business proprietor and the machine owner. As "operator," the business proprietor is responsible for suitable record keeping and is liable for the tax on machine receipts (4%, 4.25%, 4.5%, 5%, or 5.5% depending on discretionary surtax per county); the annual $30 per machine certificate fee; and the tax paid on the lease of each machine (6%, 6.25%, 6.5%, 7%, or 7.5% depending on discretionary surtax per county). However, if there is a written agreement, it is suggested that it designate: · · · who is responsible for record keeping and remitting the tax on machine receipts; who is the "operator" (this person is responsible for paying the certificate fee); and whether the arrangement is a lease of tangible personal property or a lease of real property. LINE-BY-LINE INSTRUCTIONS 1. Sales and use tax registration number: Enter the sales tax number of the "operator." If you do not have a sales tax number, you must first obtain one by completing the Application to Collect and/or Report Tax in Florida (Form DR-1). If you have machines in multiple counties, a separate DR-18 must be filed for each county. Consolidated sales tax filers will place their consolidated number here. Enter this number at the top of page 4 also. Name of operator: Enter name of operator. If the operator is a corporation, enter corporate name. Enter this name also at the top of page 4. Business name of operator: Enter the name of the business determined to be the operator. Operator's mailing address: Enter the mailing address of the operator. Certificates and renewal notices will be mailed to this address only. Daytime telephone number: Enter the area code and telephone number of the person to be contacted if the Department has questions regarding this completed application. E-mail: Enter current e-mail address. Certification by operator or operator's authorized representative: Read carefully and sign. This application will be returned if not signed by the operator or the operator's authorized representative.

2.

3. 4.

5a.

5b. 6.

7-9. Complete separate section for each location where machines are operated. Location business name: If business name where machine(s) is (are) located is different from No. 3 above, provide the complete name. Physical Address: Enter the complete address where the machine(s) is (are) located (DO NOT USE A POST OFFICE BOX). Maximum number of machines: Enter the actual number of machines operated/to be operated at this location. You may not place more machines at a location than are shown on the certificate. Check one: If you are applying for the first certificate for this location, check "new location." Enter the number of machines and multiply by $30. This is the fee amount that is due for this location. If you are adding machines to a previously issued certificate, check "update" and give amusement machine certificate number. Enter the number of additional machines and multiply by $30. This is the fee amount that is due for this location. 10. Summary of fee(s) paid: Add all new machines on this application and enter total here. Multiply total by $30. Enter this dollar amount. This is the total fee due with this application. Make checks payable to Florida Department of Revenue.

Machine Owner - If a person who owns amusement machines is also the proprietor of the business where the machines are operated, such person is deemed to be the "operator," and is responsible for suitable record keeping and is liable for the tax on machine receipts (4%, 4.25%, 4.5%, 5%, or 5.5% depending on discretionary surtax per county); the annual $30 per machine certificate fee; and the tax on machine purchases, parts and repairs (6%, 6.25%, 6.5%, 7%, or 7.5% depending on discretionary surtax per county). HOW IS THE CERTIFICATE FEE CALCULATED? The annual certificate fee is $30 per machine and is based on the maximum number of machines operated at a location. Certificates are valid for the period July 1 to June 30 each year. The annual fee is non-refundable and will not be prorated based on the time of year the certificate is purchased. WHERE DO I FILE THIS APPLICATION AND REQUIRED FEE? The Application for Amusement Machine Certificate (Form DR-18) along with the required $30 per machine fee may be mailed to: Application for Amusement Machine Certificate (DR-18), Florida Department of Revenue, 5050 west Tennessee Street, Tallahassee, Florida 32399-0100, or may be hand-delivered to the DOR service center closest to you (see the listing on the back page of these instructions). WHAT IF I WANT TO OPERATE MORE MACHINES THAN ARE LISTED ON AN AMUSEMENT MACHINE CERTIFICATE? The certificate authorizes the "operator" to operate a specified maximum number of amusement machines on a premise. If you wish to operate more than the number listed on the certificate, you must apply to the Department for a new certificate. The charge is $30 multiplied by the number of additional machines you wish to add to your operation at that location.

*DO NOT SEND CASH* For further assistance, contact Account Management at 850-488-9750 or the nearest service center.

DR-18 R. 03/06 Page 2

Florida Department of Revenue Service Centers
Alachua Service Center 14107 US Highway 441 Ste 100 Alachua FL 32615-6390 386-418-4444 (ET) Clearwater Service Center Arbor Shoreline Office Park 19337 US Highway 19 N Ste 200 Clearwater FL 33764-3149 727-538-7400 (ET) Cocoa Service Center 2428 Clearlake Rd Bldg M Cocoa FL 32922-5731 321-504-0950 (ET) Coral Springs Service Center Florida Sunrise Tower 3111 N University Dr Ste 501 Coral Springs FL 33065-5090 954-346-3000 (ET) Daytona Beach Service Center 1821 Business Park Blvd Daytona Beach FL 32114-1230 386-274-6600 (ET) Fort Myers Service Center 2295 Victoria Ave Ste 270 Fort Myers FL 33901-3871 239-338-2400 (ET) Fort Pierce Service Center Benton Building 337 N US Highway 1 Ste 207-B Fort Pierce FL 34950-4255 772-429-2900 (ET) Hollywood Service Center Taft Office Complex 6565 Taft St Ste 300 Hollywood FL 33024-4044 954-967-1000 (ET) Jacksonville Service Center 921 N Davis St A250 Jacksonville FL 32209-6829 904-359-6070 (ET) Key West Service Center 3118 Flagler Ave Key west FL 33040-4602 305-292-6725 (ET) Lake City Service Center 1401 w US Highway 90 Ste 100 Lake City FL 32055-6123 386-758-0420 (ET) Lakeland Service Center 230 S Florida Ave Ste 101 Lakeland FL 33801-4625 863-499-2260 (ET) Leesburg Service Center 1415 S 14th St Ste 103 Leesburg FL 34748-6686 352-315-4470 (ET) Maitland Service Center Ste 160 2301 Maitland Center Parkway Maitland FL 32751-4192 407-475-1200 (ET) Marianna Service Center 4230 Lafayette St Ste D Marianna FL 32446-8231 850-482-9518 (CT) Miami Service Center 8175 Nw 12th St Ste 119 Miami FL 33126-1828 305-470-5001 (ET) Naples Service Center 3073 Horseshoe Dr S Ste 110 Naples FL 34104-6145 239-434-4858 (ET) Orlando Service Center AmSouth Bank Building 5401 S Kirkman Rd 5th Floor Orlando FL 32819-7911 407-903-7350 (ET) Panama City Service Center 703 w 15th St Ste A Panama City FL 32401-2238 850-872-4165 (CT) Pensacola Service Center 3670C N L St Pensacola FL 32505-5217 850-595-5170 (CT) Port Richey Service Center 6709 Ridge Rd Ste 300 Port Richey FL 34668-6842 727-841-4407 (ET) Sarasota Service Center Sarasota Main Plaza 1991 Main St Ste 240 Sarasota FL 34236-5940 941-361-6001 (ET) Tallahassee Service Center 2410 Allen Rd Tallahassee FL 32312-2603 850-488-9719 (ET) Tampa Service Center Ste 100 6302 E Martin Luther King Blvd Tampa FL 33619-1166 813-744-6344 (ET) West Palm Beach Service Center 2468 Metrocentre Blvd west Palm Beach FL 33407-3105 561-640-2800 (ET) CT--Central Time ET--Eastern Time

For Information and Forms
Information and forms are available on our Internet site at To speak with a Department of Revenue representative, call Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m., ET, at 800-352-3671 or 850-488-6800. For a written reply to your tax questions, write: Taxpayer Services Florida Department of Revenue 1379 Blountstown Hwy Tallahassee FL 32304-3716 Persons with hearing or speech impairments may call the TDD line at 800-367-8331 or 850-922-1115. Department of Revenue service centers host educational seminars about Florida's taxes. For a schedule of upcoming seminars, · Visit us online at www.myflorida.com/dor or · Call the service center nearest you.

www.myflorida.com/dor
To receive forms by mail: · Order multiple copies of forms from our Internet site at www.myflorida.com/dor/forms or · Fax your form request to the DOR Distribution Center at 850-922-2208 or · Call the DOR Distribution Center at 850-488-8422 or · Mail your form request to: Distribution Center Florida Department of Revenue 168A Blountstown Hwy Tallahassee FL 32304-3702

Application for Amusement Machine Certificate

DR-18 R. 03/06 Page 3

This application is used for the purpose of authorizing a location to operate a specified number of coin-operated amusement machines. Every registered sales tax dealer who is the "operator" of such machines must annually renew each location's certificate with the Department of Revenue. This application must also be submitted when an operator wishes to operate more machines at a location than are listed on a previously issued Amusement Machine Certificate (Form DR-18C). Every location where coin-operated amusement machines are in operation must display a certificate which authorizes operation of a specified number of amusement machines. Each certificate must be renewed annually before July 1st. The annual fee is $30 per machine. Refer to pages 1 and 2 for line-by-line instructions for completing this application. Photocopies of the reverse side of this form may be used if needed. The original front page must always be included. This application must be completed in its entirety.

OMITTING ANY INFORMATION WILL CAUSE DELAYS IN PROCESSING. If you need assistance with this application, please call the Department's Account Management Section at 850-488-9750 or the nearest service center. If you have questions regarding the taxation of coin-operated amusement machines, please call Taxpayer Services, Monday - Friday, 8 a.m. to 7 p.m., ET, at 800-352-3671. From the option menu, select Information on Taxes or Forms or the nearest service Center. You may also find general information and forms at www.myflorida.com/dor This application and the required $30 per machine fee may be delivered to the nearest Florida Department of Revenue service center or mailed to:

Amusement Machine Certificate Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0100

Amusement Machine Operator Information Refer to the instructions to determine whether you are the "operator" of the amusement machines on location and are required to submit this application, pay the per-machine fees, and remit the tax on the machines' use and/or lease.
1. 2. 3. 4. Sales and use tax registration number

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Name of operator _____________________________________________________________________________________________ Business name of operator _____________________________________________________________________________________ Operator's mailing address _____________________________________________________________________________________ City ______________________________________________________ State ______________ ZIP ___________________________

5a.

Daytime telephone number

( ________ )_________________________ 5b. E-mail ______________________________________

PROvIDE THE INFORMATION REQUESTED ON THE REvERSE SIDE OF THIS FORM FOR MACHINE LOCATION(S). 6. Certification by operator or operator's authorized representative:

I hereby certify that the information provided on this application is, to the best of my knowledge and belief, complete, true and correct, and that each certificate obtained with this application will be conspicuously displayed on the premises whose location(s) appear(s) herein. I understand that additional fees are due and a new certificate must be obtained when I wish to operate more machines than are authorized by the certificate(s) issued pursuant to this application. _______________________________________________________________________________ Authorized signature of operator or operator's authorized representative ________________________ Date

_______________________________________________________________________________ Print or type the signature above

For DOR office use only No. of locations: ________ No. of machines: ________Amount paid: ___________ Processed by: ______________ Date: ____________

DR-18 R. 03/06 Page 4

This page may be photocopied to provide additional location information. Front page must always be included.
Sales Tax Number:

Name of Operator: ______________________________________________

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Machines are operated at the following location(s) (Note: A separate certificate will be issued for each individual location) 7.

Amusement Machine Location Information

LOCATION #1

Business name ______________________________________________________________________________________

Physical address (Do not use PO Box) ________________________________________________________________________________________ City _______________________________________ County ______________________State ______________________ ZIP __________________ Maximum number of machines to be operated at this location: Check One:



New location ............................................................................Total number of machines Update of Amusement Certificate Number ­ ­ .......Additional machines

x $30 = $ x $30 = $

8.

LOCATION #2

Business name ______________________________________________________________________________________

Physical address (Do not use PO Box) ________________________________________________________________________________________ City _______________________________________ County ______________________State ______________________ ZIP __________________ Maximum number of machines to be operated at this location: Check One:



New location ............................................................................Total number of machines Update of Amusement Certificate Number ­ ­ .......Additional machines

x $30 = $ x $30 = $

9.

LOCATION #3

Business name ______________________________________________________________________________________

Physical address (Do not use PO Box) ________________________________________________________________________________________ City _______________________________________ County ______________________State ______________________ ZIP __________________ Maximum number of machines to be operated at this location: Check One:



New location ............................................................................Total number of machines Update of Amusement Certificate Number ­ ­ .......Additional machines

x $30 = $ x $30 = $

10.

Summary of Fee(s) Paid
Total Number of Machines on this Application:

This application and the required $30 per machine fee may be delivered to the nearest Florida Department of Revenue service center or mailed to:

x $30

$
(total fee remitted with application)

Amusement Machine Certificate Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0100