Form DR-16A Application for Self-accrual Authority / Direct Pay Permit Sales and Use Tax - Florida

Form DR-16A or the "Application For Self-accrual Authority / Direct Pay Permit Sales And Use Tax" is a form issued by the Florida Department of Revenue.

The form was last revised in January 1, 2015 and is available for digital filing. Download an up-to-date Form DR-16A in PDF-format down below or look it up on the Florida Department of Revenue Forms website.

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DR-16A
Application for Self-Accrual Authority / Direct Pay Permit
R. 01/15
Sales and Use Tax
TC
Rule 12A-1.097
Florida Administrative Code
Effective 01/15
MAIL TO:
THIS AREA FOR DOR USE ONLY
ACCOUNT MANAGEMENT - MS 1-5730
PERMIT NO. ________________________________
FLORIDA DEPARTMENT OF REVENUE
5050 W TENNESSEE ST
EFF DATE __________________________________
TALLAHASSEE FL 32399-0160
EXP DATE __________________________________
PART I - Taxpayer Information
Business Name
Sales Tax Certificate Number *
-
-
Street Address
Federal Employer Identification Number (FEIN)
-
City
State
ZIP
U.S. DOT Common Carrier Number **
Name of Contact
Telephone Number - Including Area Code
-
-
Contact Mailing Address (if different than above)
City
State
ZIP
*
You must have a Florida sales tax certificate number before submitting this request. If you have not registered for sales and use
tax and do not have a certificate number, you must complete and submit a Florida Business Tax Application (Form DR-1).
PART II - Self-Accrual Category For Which You Are Applying (check only one):
Check the box next to the appropriate self-accrual authority type that describes your company’s qualifying circumstances. See
instructions for detailed descriptions of each category.
Apportionment (APP)
o Air carriers engaged in interstate or foreign commerce.
o Vessels engaged in interstate or foreign commerce.**
o Railroads engaged in interstate or foreign commerce.**
o Motor vehicles (common carriers) engaged in interstate or foreign commerce.**
** Common carriers must attach a copy of their letter of authority from the U.S. Department of Transportation (DOT).
Purchases of Tangible Personal Property (TPP)
o Annual purchases of tangible personal property in excess of $10 million.
o Annual purchases of tangible personal property in excess of $100,000 – taxability unknown at time of purchase.
Promotional Materials (PRO)
o Purchases of promotional materials – taxability unknown at time of purchase.
Real Property Leases (RPL)
o Dealers required to remit sales tax electronically, who lease property from a number of independent property owners.
o Dealers who lease real property from a number of independent property owners and, except for the lease or license
to the dealer, would not be required to register as dealers engaged in the business of leasing real property.
o Operators of amusement or vending machines who lease real property from others.
PART III - Certification
I understand that a Sales and Use Tax Direct Pay Permit may only be used for the purposes indicated in section 212.183, Florida
Statutes. Under penalties of perjury, I declare that I have read the information provided in this Application and that the facts stated in
it are true.
____________________________________________________
____________________________________________________
Signature of Owner, Partner, Corporate Officer or Member
Title
____________________________________________________
____________________________________________________
Print Name
Date
DR-16A
Application for Self-Accrual Authority / Direct Pay Permit
R. 01/15
Sales and Use Tax
TC
Rule 12A-1.097
Florida Administrative Code
Effective 01/15
MAIL TO:
THIS AREA FOR DOR USE ONLY
ACCOUNT MANAGEMENT - MS 1-5730
PERMIT NO. ________________________________
FLORIDA DEPARTMENT OF REVENUE
5050 W TENNESSEE ST
EFF DATE __________________________________
TALLAHASSEE FL 32399-0160
EXP DATE __________________________________
PART I - Taxpayer Information
Business Name
Sales Tax Certificate Number *
-
-
Street Address
Federal Employer Identification Number (FEIN)
-
City
State
ZIP
U.S. DOT Common Carrier Number **
Name of Contact
Telephone Number - Including Area Code
-
-
Contact Mailing Address (if different than above)
City
State
ZIP
*
You must have a Florida sales tax certificate number before submitting this request. If you have not registered for sales and use
tax and do not have a certificate number, you must complete and submit a Florida Business Tax Application (Form DR-1).
PART II - Self-Accrual Category For Which You Are Applying (check only one):
Check the box next to the appropriate self-accrual authority type that describes your company’s qualifying circumstances. See
instructions for detailed descriptions of each category.
Apportionment (APP)
o Air carriers engaged in interstate or foreign commerce.
o Vessels engaged in interstate or foreign commerce.**
o Railroads engaged in interstate or foreign commerce.**
o Motor vehicles (common carriers) engaged in interstate or foreign commerce.**
** Common carriers must attach a copy of their letter of authority from the U.S. Department of Transportation (DOT).
Purchases of Tangible Personal Property (TPP)
o Annual purchases of tangible personal property in excess of $10 million.
o Annual purchases of tangible personal property in excess of $100,000 – taxability unknown at time of purchase.
Promotional Materials (PRO)
o Purchases of promotional materials – taxability unknown at time of purchase.
Real Property Leases (RPL)
o Dealers required to remit sales tax electronically, who lease property from a number of independent property owners.
o Dealers who lease real property from a number of independent property owners and, except for the lease or license
to the dealer, would not be required to register as dealers engaged in the business of leasing real property.
o Operators of amusement or vending machines who lease real property from others.
PART III - Certification
I understand that a Sales and Use Tax Direct Pay Permit may only be used for the purposes indicated in section 212.183, Florida
Statutes. Under penalties of perjury, I declare that I have read the information provided in this Application and that the facts stated in
it are true.
____________________________________________________
____________________________________________________
Signature of Owner, Partner, Corporate Officer or Member
Title
____________________________________________________
____________________________________________________
Print Name
Date

Download Form DR-16A Application for Self-accrual Authority / Direct Pay Permit Sales and Use Tax - Florida

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