Dr 1214 Form – Fill Out and Use This PDF

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:

New Business

Expanding Business

Spaceport Activity

Mining Activity

1.(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 oficer or employee of the business.)

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

2.(a) Project Location (Address where the machinery and equipment will be or has been installed):

________________________________________________________________________________________________________________

(c)Project Description (Explain in full detail the purpose and scope of work to be accomplished by the project.):

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

		(Attach additional sheet, if necessary)
(d) Is any qualifying machinery and equipment going to be leased?			Yes	No
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 ile 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?

________________________________________________________________________________________________________________

(c) Is this product or a similar product already being made at another Florida location of this company?

Yes

No If yes,

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.Has this business previously applied for this exemption? If so, when? ____________________________________________________

2.(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.Has this business previously applied for this exemption? If so, when? ____________________________________________________

2.(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 ile 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 ile 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) 617-8346.

For Florida Department of Revenue use ONLY — Do not write in this space.

Sales Tax Number: _______________________________________________