Form DR-26SIGEN "Application for Refund - Sales Tax Paid on Generators for Nursing Homes or Assisted Living Facilities" - Florida

What Is Form DR-26SIGEN?

This is a legal form that was released by the Florida Department of Revenue - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2018;
  • The latest edition provided by the Florida Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DR-26SIGEN by clicking the link below or browse more documents and templates provided by the Florida Department of Revenue.

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Download Form DR-26SIGEN "Application for Refund - Sales Tax Paid on Generators for Nursing Homes or Assisted Living Facilities" - Florida

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DR-26SIGEN
N. 05/18
Application for Refund - Sales Tax Paid on Generators
Rule 12AER18-02, F.A.C.
Effective 05/18
for Nursing Homes or Assisted Living Facilities
Page 1 of 2
Section 1: Taxpayer Information
Refund Applicant Name:
Federal Employer Identification Number (FEIN):
Facility License Number:
Refund Applicant Mailing Street Address:
Mailing City:
State:
ZIP:
Facility Street Address:
Facility City:
State:
ZIP:
Telephone Number (Include area code):
Fax Number (Include area code):
Email Address (Optional):
Section 2: Taxpayer Representative - This section is to be completed when a taxpayer representative is requesting the refund. A
signed Florida Department of Revenue Power of Attorney and Declaration of Representative (Form DR-835) must be attached.
Representative Name:
Street or Mailing Address of Representative:
City:
State:
ZIP:
Telephone Number (Include area code):
Fax Number (Include area code):
Email Address (Optional):
Section 3: Purchase Information - Enter the date(s) the purchase was made:
Purchase Date: (MM/DD/YY)
Amount Paid:
 Invoices/Receipts Attached
Section 4: Refund Amount - Enter the refund amount, not to exceed $15,000
Refund Amount:
Section 5: Applicant Affidavit -
The purchaser of the equipment used to generate emergency electricity in a nursing home facility or an assisted living
facility must sign the following affidavit:
Applicant Name Printed
I, ___________________________________________, hereby affirm that the equipment for which I have requested a refund of sales tax paid will be used
to generate emergency electric energy at a nursing home facility as defined in s. 400.021(12), Florida Statutes, or an assisted living facility as defined in
s. 429.02(5), Florida Statutes. I understand that a person who furnishes a false affidavit to the Florida Department of Revenue is subject to a mandatory
penalty of 200% of the evaded tax, in addition to being liable for fine and punishment as provided by law for a conviction of a felony of the third degree.
Under penalties of perjury, I declare that I have read the foregoing affidavit and the facts stated in it are true to the best of my knowledge and belief.
Signature of Purchaser: _____________________________________________
Date: ________________________________________________
Section 6: Authorization and Signature
Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true.
Taxpayer Signature: _______________________________________________________________
OR
Date: ______________________
Representative Signature: ___________________________________________________________
DR-26SIGEN
N. 05/18
Application for Refund - Sales Tax Paid on Generators
Rule 12AER18-02, F.A.C.
Effective 05/18
for Nursing Homes or Assisted Living Facilities
Page 1 of 2
Section 1: Taxpayer Information
Refund Applicant Name:
Federal Employer Identification Number (FEIN):
Facility License Number:
Refund Applicant Mailing Street Address:
Mailing City:
State:
ZIP:
Facility Street Address:
Facility City:
State:
ZIP:
Telephone Number (Include area code):
Fax Number (Include area code):
Email Address (Optional):
Section 2: Taxpayer Representative - This section is to be completed when a taxpayer representative is requesting the refund. A
signed Florida Department of Revenue Power of Attorney and Declaration of Representative (Form DR-835) must be attached.
Representative Name:
Street or Mailing Address of Representative:
City:
State:
ZIP:
Telephone Number (Include area code):
Fax Number (Include area code):
Email Address (Optional):
Section 3: Purchase Information - Enter the date(s) the purchase was made:
Purchase Date: (MM/DD/YY)
Amount Paid:
 Invoices/Receipts Attached
Section 4: Refund Amount - Enter the refund amount, not to exceed $15,000
Refund Amount:
Section 5: Applicant Affidavit -
The purchaser of the equipment used to generate emergency electricity in a nursing home facility or an assisted living
facility must sign the following affidavit:
Applicant Name Printed
I, ___________________________________________, hereby affirm that the equipment for which I have requested a refund of sales tax paid will be used
to generate emergency electric energy at a nursing home facility as defined in s. 400.021(12), Florida Statutes, or an assisted living facility as defined in
s. 429.02(5), Florida Statutes. I understand that a person who furnishes a false affidavit to the Florida Department of Revenue is subject to a mandatory
penalty of 200% of the evaded tax, in addition to being liable for fine and punishment as provided by law for a conviction of a felony of the third degree.
Under penalties of perjury, I declare that I have read the foregoing affidavit and the facts stated in it are true to the best of my knowledge and belief.
Signature of Purchaser: _____________________________________________
Date: ________________________________________________
Section 6: Authorization and Signature
Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true.
Taxpayer Signature: _______________________________________________________________
OR
Date: ______________________
Representative Signature: ___________________________________________________________
DR-26SIGEN
N. 05/18
Instructions
Page 2 of 2
Florida law provides that any equipment used to generate
required documentation, to the Department within six
months after the date of purchase.
emergency electric energy for use at a nursing home
facility or an assisted living facility purchased during
the period July 1, 2017, through December 31, 2018,
Documentation Required
is exempt from sales and use tax and discretionary
A copy of each sales invoice or other proof of purchase
sales surtax. The exemption is limited to a maximum
of qualified equipment showing the Florida sales tax paid,
of $15,000 in sales tax and surtax paid on equipment
the date of purchase, and the name and address of the
purchased for any single facility.
dealer from whom the materials were purchased must be
submitted with your application.
Is there a time limit to apply?
You may choose to submit the required documentation
Yes. For purchases of equipment made on or after
electronically instead of providing paper copies. Contact
July 1, 2017, and before March 23, 2018, you must
Refunds at 850-617-8585 for more information.
submit a completed Application for Refund - Sales
Tax Paid on Generators for Nursing Homes or
Upon receipt of an application, the application, supporting
Assisted Living Facilities (Form DR-26SIGEN),
information, and documentation will be reviewed. You will
including the required documentation, to the Department
be notified if additional information or documentation is
no later than September 23, 2018.
needed.
For equipment purchased during the period
Once your application contains all information and
March 23, 2018, through December 31, 2018, for which
documentation needed by the Department to determine
you paid Florida sales tax and surtax, you must submit
eligibility and the amount of the refund claim due, your
a completed Application for Refund - Sales Tax
refund claim will be processed.
Paid on Generators for Nursing Homes or Assisted
Living Facilities (Form DR-26SIGEN), including the
Mail this application and applicable documentation to:
For more information about the documentation
Florida Department of Revenue
needed to process your refund, or to check on the
Refunds
OR
application status, call Refunds at 850-617-8585.
PO Box 6490
Fax 850-410-2526
Tallahassee FL 32314-6490
Contact Us
Information, forms, and tutorials are available on the Department’s website at floridarevenue.com.
Subscribe to Receive Email Alerts from the Department.
Subscribe to receive an email for due date reminders,Tax Information Publications (TIPs) or proposed rules, notices of
rule development workshops, and more. Subscribe today at floridarevenue.com/dor/subscribe.
Reference
The following document was mentioned in this form and is incorporated by reference in the rule indicated below.
The form is available online at floridarevenue.com/forms.
Form DR-835
Florida Department of Revenue Power of Attorney
Rule 12-6.0015, F.A.C.
and Declaration of Representative
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