In an effort to improve the quality of care provided to patients, several hospitals have begun using a new form, the Dr 15Sw form. The form is designed to help doctors more easily identify and track patient progress. The Dr 15Sw form is also intended to help doctors more accurately assess and diagnose patients. So far, the feedback on the new form has been positive, with doctors reporting that they are able to better manage their patients' care using the form.
| Question | Answer |
|---|---|
| Form Name | Dr 15Sw Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | florida solid waste form, florida dr 15sw waste, florida waste form, florida solid surcharge return |
Solid Waste and Surcharge Return
R. 01/15
Rule
Complete back of return FIRST!
You may ile and pay the gross receipts tax on
Florida Department of Revenue
5050 W Tennessee St
Tallahassee, FL
Please read the Instructions for
www.mylorida.com/dor
Solid Waste and Surcharge Return HD/PM DATE:
Certiicate Number |
Reporting Period |
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Name
Address
City/St
ZIP
FLORIDA DEPARTMENT OF REVENUE 5050 W TENNESSEE ST TALLAHASSEE FL
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5. |
Total tax, fees, and |
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surcharges due (from |
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Line 5 on reverse side) |
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Less credits |
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7. |
Net amount due |
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Plus penalty |
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9. |
Plus interest |
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10. |
Amount due with return |
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Due:
Late After:
Check here if payment was made electronically.
9100 0 20159999 0038003031 8 4999999999 0000 5
Solid Waste and Surcharge Return HD/PM DATE:
Certiicate Number |
Reporting Period |
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Name
Address
City/St
ZIP
FLORIDA DEPARTMENT OF REVENUE 5050 W TENNESSEE ST TALLAHASSEE FL
5. |
Total tax, fees, and |
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surcharges due (from |
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Line 5 on reverse side) |
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6. |
Less credits |
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7. |
Net amount due |
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8. |
Plus penalty |
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9. |
Plus interest |
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10. |
Amount due with return |
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Due:
Late After:
Check here if payment was made electronically.
9100 0 20159999 0038003031 8 4999999999 0000 5
To order replacement coupon books: Call Taxpayer Services, 8 a.m. to 7 p.m., ET, Monday through Friday, excluding holidays, at
If your information is not printed on this return, write your business name, address, certiicate number, and reporting period in the spaces provided.
Electronic Filing and Payment: You can ile and pay solid waste taxes, fees, and surcharges by using the Department’s convenient, free, and secure website or you may purchase software from a vendor.
Due Dates: Returns and payments are due on the 1st and late after the 20th day of the month following each reporting period.
R. 01/15
Page 2
If the 20th falls on a Saturday, Sunday, state or federal holiday, your return must be postmarked or
Penalty and Interest: If you are late iling your return or paying the taxes, fees, and surcharges due, add a late penalty of 10% of the net amount due, but no less than $50. If your payment is late, you owe interest on the net amount due. Interest rates, including daily rates, are published in Tax Information Publications (TIPs) that are updated semiannually on January 1 and July 1 each year and posted on our website.
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A. |
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B. |
Less Exempt Receipts |
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C. |
Taxable Gross Receipts |
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Under penalties of perjury, I declare that I have read this return and the facts stated in it are true.
Signature of Taxpayer |
Date |
Telephone # |
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Signature of Preparer |
Date |
Telephone # |
1. |
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Multiply Taxable Gross Receipts by 2%(.02) |
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and enter this amount on Line 1 |
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2. |
New Tire Fees Due |
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3. |
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4. |
Rental Car Surcharge Due |
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5. |
Total Amount Due - |
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Bring amount to Line 5 on front of return. |
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A. |
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B. |
Less Exempt Receipts |
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C. |
Taxable Gross Receipts |
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Under penalties of perjury, I declare that I have read this return and the facts stated in it are true.
Signature of Taxpayer |
Date |
Telephone # |
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Signature of Preparer |
Date |
Telephone # |
1.
Multiply Taxable Gross Receipts by 2%(.02) and enter this amount on Line 1
2.New Tire Fees Due
3.
4.Rental Car Surcharge Due
5.Total Amount Due -
Bring amount to Line 5 on front of return.
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