Free GT-200407 - Florida

Sample Form - Provided as a courtesy by the Department of Revenue FLORIDA SECONDARY METALS RECYCLER PURCHASE TRANSACTION FORM
RE: Regulated Metals, Chapter 538, Part II, Florida Statutes [This form must be retained for 5 years from the date of the transaction]

RECYCLER NAME & STREET ADDRESS

TRANSACTION INFORMATION Person Entering Ticket:
AM PM

Date

TIME

DATE OF BIRTH

SEX (M/F)

RACE

NAME (Last, First, Middle) (Exemptions may apply pursuant to s. 538.19(2008) F.S.)

W. WHITE B. BLACK I. AMERICAN INDIAN A. ASIAN/ORIENTAL

MONTH

DAY

YEAR

INDIVIDUAL DELIVERING METAL

RESIDENTIAL ADDRESS (STREET, APT. NO., CITY, STATE & ZIP)

( (

HOME PHONE (Area Code & Number)

)

_

EMPLOYER PHONE (Area Code & Number)

DL # / GOVERNMENT ISSUED PHOTO ID #

TYPE

ISSUING AGENCY or STATE

)

_

PLACE OF EMPLOYMENT and ADDRESS

HEIGHT

WEIGHT

EYE COLOR

HAIR COLOR

IDENTIFYING MARKS (SCARS / MARKS / TATOOS)

VEHICLE USED TO TRANSPORT DESCRIBED METAL: MAKE TRAILER USED TO TRANSPORT DESCRIBED METAL: MAKE MODEL WEIGHT or FORM OF PAYMENT: TAG# VOLUME CASH CHECK OTHER VOLUME CASH CHECK OTHER VOLUME CASH CHECK OTHER AMOUNT PAID AMOUNT PAID AMOUNT PAID MODEL TAG#

REGULATED R E GUL AT ED REGULATED METAL #1 ME TA L #3 METAL #2 D ES C R I PTI ON DESCRIPTION DESCRIPTION

TYPE OF METAL: MODEL / MANUFACTURER / SERIAL #

QUANTITY or ADDITIONAL DESCRIPTION

$

TYPE OF METAL: MODEL / MANUFACTURER / SERIAL #

QUANTITY or ADDITIONAL DESCRIPTION

WEIGHT or FORM OF PAYMENT:

$

TYPE OF METAL: MODEL / MANUFACTURER / SERIAL #

QUANTITY or ADDITIONAL DESCRIPTION

WEIGHT or FORM OF PAYMENT:

$

Florida law requires the secondary metals recycler to maintain a photograph / videotape / digital image of the regulated metals being sold. s. 538.19(2)(i), F.S. (2008). Completed? YES NO

TOTAL PAID $
Right Thumb Print of Seller / Individual delivering metal

RECYCLER

Florida law requires the secondary metals recycler to maintain a photograph / videotape / or similair likeness of the person receving consideration in which such persons facial features are clearly visible. s. 538.19(2)(j), F.S. (2008). Completed? YES NO Florida law requires that if this purchase involves a stainless steel beer keg, the seller must provide written documentation from the manufacturer that the seller is the owner of the stainless steel beer keg or is an employee or agent of the manufacturer. s.538.19(2) (f), F.S. (2008). Did the seller provide this documentation? YES NO

I am the rightful owner of, or entitled to sell the regulated metals property being sold:
Signature of Individual Delivering Regulated Metal Date

Note: Florida Statute 538.23(3) states: "Any person who knowingly gives false verification of ownership or who gives a false or altered identification and who receives money or other consideration from a secondary metals recycler in return for regulated metals property commits (a) a felony of the third degree, punishable as provided in s. 775.082, s.775.083, or s. 775.084, if the value of the money or other consideration received is less than $300. (b) a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, if the value of the money or other consideration received is $300 or more."

EFFECTIVE OCTOBER 1, 2008

(FDLE ver.8-2008)

GT-200407 R. 08/08