Form FDACS-03524 "Odorizers / Importers Quarterly Remittance Report" - Florida

Form FDACS-03524 or the "Odorizers / Importers Quarterly Remittance Report" is a form issued by the Florida Department of Agriculture and Consumer Services.

The form was last revised in April 1, 2018 and is available for digital filing. Download an up-to-date Form FDACS-03524 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-03524 "Odorizers / Importers Quarterly Remittance Report" - Florida

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Florida Department of Agriculture and Consumer Services
Remit Payment Online at:
Division of Consumer Services
www.FreshFromFlorida.com
- or -
ODORIZERS / IMPORTERS
Check or Money Order payable to
QUARTERLY REMITTANCE REPORT
FDACS and mail with application
to:
Section 527.23, Florida Statutes
ADAM H. PUTNAM
Rule 5J-20.004, Florida Administrative Code
FDACS
COMMISSIONER
P.O. Box 6700
Tallahassee, Florida 32314-6700
INSTRUCTIONS
This form is required for verification of assessments due on sales or import of odorized propane gas pursuant to Section
527.23, Florida Statutes. Complete this form and return it WITH YOUR REMITTANCE PAYMENT to the address listed in
the upper, right corner within 45 days of the applicable quarter-ending date. THE QUARTER ENDING DATES ARE
SEPTEMBER 30, DECEMBER 31, MARCH 31, AND JUNE 30. PENALTIES MAY BE ASSESSED FOR LATE OR NON-
PAYMENT PURSUANT TO CHAPTER 527, FLORIDA STATUTES.
CALCULATING YOUR ASSESSMENT: Calculate the amount of the assessment due using the table below. EACH LOAD
MUST BE DOCUMENTED SEPARATELY BY TICKET OR BILL OF LADING NUMBER. The “Load Tracking Sheet”
included with this form may be used to record each load, or you may attach supporting schedules that include the required
information. Extra copies of the form may be made, as-needed. Make sure information recorded below includes totals
from all attachments.
If you wish to submit load tracking information in electronic format, the information can be emailed to
LPGASPERC@FreshFromFlorida.com. Please indicate the format of the document when sending and include your email
address and a contact phone number.
IF YOUR ASSESSMENT IS BEING PAID BY YOUR GAS SUPPLIER, PLEASE RETURN THIS FORM WITH A LIST OF
YOUR SUPPLIER(S)’ NAME(S) AND PHONE NUMBER(S).
Company Name
Company Id
Mailing Address of Business:
City
State
Zip Code
Contact Person (name & title):
Phone Number
Fax Number
Email Adress
( )
( )
FEDERAL EMPLOYER’S IDENTIFICATION NUMBER:
Questions should be
directed to: (850) 410-3664
F&A Use Only
Org. Code: 42 10 09 10 000
EO A2
Object Code: 001208
FDACS-03524 Rev. 04/18
Page 1 of 3
Florida Department of Agriculture and Consumer Services
Remit Payment Online at:
Division of Consumer Services
www.FreshFromFlorida.com
- or -
ODORIZERS / IMPORTERS
Check or Money Order payable to
QUARTERLY REMITTANCE REPORT
FDACS and mail with application
to:
Section 527.23, Florida Statutes
ADAM H. PUTNAM
Rule 5J-20.004, Florida Administrative Code
FDACS
COMMISSIONER
P.O. Box 6700
Tallahassee, Florida 32314-6700
INSTRUCTIONS
This form is required for verification of assessments due on sales or import of odorized propane gas pursuant to Section
527.23, Florida Statutes. Complete this form and return it WITH YOUR REMITTANCE PAYMENT to the address listed in
the upper, right corner within 45 days of the applicable quarter-ending date. THE QUARTER ENDING DATES ARE
SEPTEMBER 30, DECEMBER 31, MARCH 31, AND JUNE 30. PENALTIES MAY BE ASSESSED FOR LATE OR NON-
PAYMENT PURSUANT TO CHAPTER 527, FLORIDA STATUTES.
CALCULATING YOUR ASSESSMENT: Calculate the amount of the assessment due using the table below. EACH LOAD
MUST BE DOCUMENTED SEPARATELY BY TICKET OR BILL OF LADING NUMBER. The “Load Tracking Sheet”
included with this form may be used to record each load, or you may attach supporting schedules that include the required
information. Extra copies of the form may be made, as-needed. Make sure information recorded below includes totals
from all attachments.
If you wish to submit load tracking information in electronic format, the information can be emailed to
LPGASPERC@FreshFromFlorida.com. Please indicate the format of the document when sending and include your email
address and a contact phone number.
IF YOUR ASSESSMENT IS BEING PAID BY YOUR GAS SUPPLIER, PLEASE RETURN THIS FORM WITH A LIST OF
YOUR SUPPLIER(S)’ NAME(S) AND PHONE NUMBER(S).
Company Name
Company Id
Mailing Address of Business:
City
State
Zip Code
Contact Person (name & title):
Phone Number
Fax Number
Email Adress
( )
( )
FEDERAL EMPLOYER’S IDENTIFICATION NUMBER:
Questions should be
directed to: (850) 410-3664
F&A Use Only
Org. Code: 42 10 09 10 000
EO A2
Object Code: 001208
FDACS-03524 Rev. 04/18
Page 1 of 3
PAYMENT IS BEING SUBMITTED FOR
STATE FISCAL YEAR: 20 __
QUARTER:
Company ID:
Name:
ASSESSMENT CALCULATION TABLE
1. Enter Total Gallons Imported into or Odorized in Florida (from Column A of Load
Tracking Sheet)
2. Enter Total Gallons sold for consumption outside of Florida (from Column B of Load
Tracking Sheet)
3.
Total gallons to which assessment is to be applied (subtract line 2 from line 1)
$
4. AMOUNT DUE: Multiply amount on line 3 x $.003 & enter here »
I hereby certify that I was the owner of the stated volumes of propane at the time
they were odorized in Florida or imported into this state and that the information
contained in this report is true and accurate.
SIGNATURE:
PRINT NAME & TITLE:
CONTACT PHONE NUMBER:
DATE COMPLETED:
FOR BUREAU USE ONLY
REVIEWED
BY:_______________________________
DATE POSTED: _____/____/____________
FDACS-03524 Rev. 04/18
Page 2 of 3
LOAD TRACKING SHEET
This is page _______ of ______ pages submitted by:
Company id:
Name: _________________________________
(COLUMN A)
(COLUMN B)
Load Number
Gallons Imported into
Gallons Exported for
Date
(Ticket or Bill of
Customer Name & City
or Odorized in the
consumption outside
Lading No.)
State of Florida
the State of Florida
TOTAL GALLONS (this page)
FDACS-03524 Rev. 04/18
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