DEP Form 18-21.900(1) "Billing Information Form" - Florida

DEP Form 18-21.900(1) is a Florida Department of Environmental Protection form also known as the "Billing Information Form". The latest edition of the form was released in February 15, 2016 and is available for digital filing.

Download a PDF version of the DEP Form 18-21.900(1) down below or find it on Florida Department of Environmental Protection Forms website.

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Download DEP Form 18-21.900(1) "Billing Information Form" - Florida

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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF STATE LANDS
Bureau of Public Lands Administration
BILLING INFORMATION FORM
Payments for Lease Number:
Lessee Name:
Management Company:
Billing/Mailing Address:
City:
State:
Zip Code:
Telephone Number:
Fax Number:
Email Address:
Facility Address:
City:
State:
Zip Code:
SALES TAX CERTIFICATION/EXEMPTION
Six percent (6%) sales tax is due on each lease fee payment unless the Lessee can claim an ownership
exemption. I/We are exempt from sales tax for the reason checked below.
☐ Government Agency: ____________________________________ (Exemption Number)
☐ Exempt Organization: ____________________________________ (Exemption Number)
☐ Lease and collect sales tax on all available dock spaces.
__________________________________________ (Sales Tax Number)
☐ Lease and collect sales tax on some available dock spaces but fully assume the responsibility to remit
six percent sales tax on that portion of space on which no sales tax is charged.
__________________________________________ (Sales Tax Number)
☐ None of the above can be claimed.
A copy of the Florida Annual Resale Certificate for Sales Tax or the Certificate of Exemption
must accompany this form to claim this exemption pursuant to Section 212.07(1)(b), F.S.
Form Number: 18-21.900(1), Effective 10-15-98
revised: 02-15-2016]
Page 1 of 2
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF STATE LANDS
Bureau of Public Lands Administration
BILLING INFORMATION FORM
Payments for Lease Number:
Lessee Name:
Management Company:
Billing/Mailing Address:
City:
State:
Zip Code:
Telephone Number:
Fax Number:
Email Address:
Facility Address:
City:
State:
Zip Code:
SALES TAX CERTIFICATION/EXEMPTION
Six percent (6%) sales tax is due on each lease fee payment unless the Lessee can claim an ownership
exemption. I/We are exempt from sales tax for the reason checked below.
☐ Government Agency: ____________________________________ (Exemption Number)
☐ Exempt Organization: ____________________________________ (Exemption Number)
☐ Lease and collect sales tax on all available dock spaces.
__________________________________________ (Sales Tax Number)
☐ Lease and collect sales tax on some available dock spaces but fully assume the responsibility to remit
six percent sales tax on that portion of space on which no sales tax is charged.
__________________________________________ (Sales Tax Number)
☐ None of the above can be claimed.
A copy of the Florida Annual Resale Certificate for Sales Tax or the Certificate of Exemption
must accompany this form to claim this exemption pursuant to Section 212.07(1)(b), F.S.
Form Number: 18-21.900(1), Effective 10-15-98
revised: 02-15-2016]
Page 1 of 2
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF STATE LANDS
Bureau of Public Lands Administration
BILLING INFORMATION FORM
I/We certify that the above information is correct and agree to NOTIFY THE BUREAU OF PUBLIC
LAND ADMINISTRATION’S ACCOUNTING SECTION AT (850) 245-2720 within 30 days of the
date of any change in the above designated billing agent, phone number, fax number or Lessee’s tax
status.
Signed:
Lessee / Authorized Entity
Date:
/
/
For Recurring Revenue Section Use Only
,
/
Billing Form to Accountant:
Originator’s signature
,
/
Data Entered by Accountant:
Accountant’s signature
Form Number: 18-21.900(1), Effective 10-15-98
revised: 02-15-2016]
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