Free DR-1214 - Florida

Application for Temporary Tax Exemption Permit

DR-1214 R. 07/06
Rule 12A-1.097 Florida Administrative Code Effective 04/08

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: 1. New Business Expanding Business Spaceport Activity Mining Activity

(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) Yes No (d) Is any qualifying machinery and equipment going to be leased? 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

Yes No If yes, (c) Is this product or a similar product already being made at another Florida location of this company? 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)? _________________________________________ _______________________________________________________________________________________________________________

SECTION II
If claiming exemption as a new business, please answer the following: 1. 2. Has this business previously applied for this exemption? If so, when? ____________________________________________________ (a) Approximate Beginning and Completion Date of Construction (if construction is necessary): Beginning Date: ______________________________________ Completion Date: ______________________________________ (b) Approximate Beginning Date of Machinery and Equipment Purchases: _________________________________________________ (c) Estimated Start Date of Production: _______________________________________________________________________________

SECTION III
If claiming exemption as an expanding business, please answer the following: 1. 2. Has this business previously applied for this exemption? If so, when? ____________________________________________________ (a) Approximate Beginning and Completion Date of Construction (if construction is necessary): Beginning Date: ______________________________________ Completion Date: ______________________________________ (b) Approximate Beginning Date of Installation of Machinery and Equipment Purchases: ____________________________________ (c) Estimated Date of Completion of Machinery and Equipment Installation:________________________________________________ 3. Please answer the following regarding productive output for your expansion project. (a) Specfy the unit of measure that you will use to measure your increase in productive output; i.e., pounds, tons, pieces, gallons, cubic yards, sheets, etc. (Selling price or labor hours cannot be used.) _______________________________________ ________________________________________________________________________________________________________________

% (b) What is your expected percent increase in productive output following the expansion project? ____________________________ ADDITIONAL REMARkS
___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Important: A qualifying business entity must file this form whether it seeks to make purchases of machinery and equipment tax-exempt or seeks a refund of previously paid taxes. To avoid any delays in obtaining the permit or a refund, the application must be fully completed and returned to the Department of Revenue. A business that seeks a refund of previously paid tax must file an Application for Refund - Sales and Use Tax (Form DR-26S) within the applicable statutory limits. See s. 215.26(2), F.S. For additional information, call (850) 488-0717. _______________________________________ ________________ Signature Date __________________________________________________________ Print Name __________________________________________________________ Title

Mail this form to: DIRECTOR TECHNICAL ASSISTANCE AND DISPuTE RESOLuTION FLORIDA DEPARTMENT OF REVENuE PO BOx 7443 TALLAHASSEE FL 32314-7443

For Florida Department of Revenue use ONLY -- Do not write in this space. The above project is: (check one) Approved as a new business Approved as an expanding business Approved as a spaceport activity Approved as a mining activity Not approved for the exemption Business Name: _________________________________________________ Sales Tax Number: _______________________________________________ Permit _________________________
From

_____________________________
To

Permit Number ________________________________________________ Refund No Permit Issued

_________________________________________________________________
(Signature of Authorized Agent) Date