Free DR-15SWCS - Florida

DR-15SWCS R. 01/09

Solid Waste and Surcharge Return

rule 12A-16.008 Florida Administrative Code Effective 01/09

This return and your payment are due on the 1st and late after the 20th day of the month following the collection period. To avoid penalty and interest, this return must be postmarked or hand-delivered to the Department no later than the 20th, even if no tax is due.

Complete back of return FIRST!

Florida Department of Revenue
Certificate Number

Solid Waste and Surcharge Return
Collection Period

DR-15SW R. 01/09 dor use oNly
postmark or hand delivery date

Name Address City/St/ZIP

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DR-15SW
5. Total amount collected (from Line 5 on reverse side) 6. Less credits 7. Net amount due 8. Plus penalty

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9. Plus interest

Do not write in the space below. 10. Amount due with return

. . . . . .
DR-15SW R. 01/09

Due: late After: Check here if payment was made electronically.

9100 0 20099999 0038003031 7 4999999999 0000 5 **Detach coupon and return with payment** Solid Waste and Surcharge Return
Collection Period

Florida Department of Revenue
Certificate Number

DR-15SW
Name Address City/St/ZIP

dor use oNly
postmark or hand delivery date

5. Total amount collected (from Line 5 on reverse side) 6. Less credits 7. Net amount due 8. Plus penalty 9. Plus interest

Do not write in the space below. 10. Amount due with return Due: late After: Check here if payment was made electronically.

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, , , , , ,

. . . . . .

9100 0 20099999 0038003031 7 4999999999 0000 5

DR-15SWCS R. 01/09 Page 2

Instructions for Completing a Machine-readable Form
Use black ink. Do not make any stray marks in boxed field areas. Hand-Printed: If hand printing this document, print your numbers as shown and write one number per box. Write within the boxes.

Instructions for Mailing your return and Payment
Make your check payable to the Florida Department of Revenue. If you are using your personalized tax return, please use the window-style envelope provided to mail your tax return and payment to the Department. Make sure you insert the tax return so you can see the Department's address through the window. If you are using a tax return without your name and address preprinted on it, mail your tax return and payment to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0120

, 2 5 00
Machine reads a $25.00 payment. Machine-Typed: If typing this document, type through the boxes and type all of your numbers together. Do not use a comma, period, or dash (, . or -). Indicate cents with two numbers.

, 2500
Machine reads a $25.00 payment. Solid Waste and Surcharge Return 1. Dry-cleaning gross receipts subject to tax (see schedule below) 2. Number of new tires subject to fee 3. Number of batteries subject to fee 4. Total rental days subject to surcharge Column A

Instructions for Changing your Account Information
If you change your business name, location, or mailing address; close or sell your business; or change your legal entity, notify the Department as soon as possible.

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Column B
Rate or Fee

Column C - Amounts Collected

X 2% = X $1.00 = X $1.50 = X $2.00 =

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. .0 0 . 0 .0 0 .

schedule of Gross receipts Tax on dry-Cleaning/laundering a. Total of gross receipts b. Less exempt receipts c. Taxable gross receipts (a minus b, carry to Line 1, Column A above)

. . .

5. Total amount collected (enter

on front, Line 5) Under penalties of perjury, I declare that I have read this return and the facts stated in it are true. Signature of Taxpayer Signature of Preparer Date Date

,

Solid Waste and Surcharge Return 1. Dry-cleaning gross receipts subject to tax (see schedule below) 2. Number of new tires subject to fee 3. Number of batteries subject to fee 4. Total rental days subject to surcharge

Column A

,

, , , ,

, , ,

.

Column B
Rate or Fee

Column C - Amounts Collected

X 2% = X $1.00 = X $1.50 = X $2.00 =

, ,

, , , ,

. .0 0 . 0 .0 0 .

schedule of Gross receipts Tax on dry-Cleaning/laundering a. Total of gross receipts b. Less exempt receipts c. Taxable gross receipts (a minus b, carry to Line 1, Column A above)

. . .

5. Total amount collected (enter

on front, Line 5) Under penalties of perjury, I declare that I have read this return and the facts stated in it are true. Signature of Taxpayer Signature of Preparer Date Date

,