DR-1214
                                             Application for Temporary                                                       R. 01/16
                                             Tax Exemption Permit                                                     Rule 12A-1.097
                                                                                                    Florida Administrative Code
                                                                                                                      Effective 01/16

  SECTION I
This application is to be completed for each project for which exemption from Florida sales and/or use tax is claimed pursuant to 
section 212.08(5)(b), Florida Statutes, and Rule 12A-1.096, Florida Administrative Code. See reverse side for mailing adress.
   EXEMPTION CLAIMED AS:          New Business       Expanding Business  Spaceport Activity          Mining Activity
1. (a)  Business Name: _________________________________________________________________________________________________
   (b)  Mailing Address:  ________________________________________________________________________________________________
    City, State, ZIP:  _________________________________________________________________________________________________
   (c)  Website address: ________________________________________________________________________________________________
   (d)  Florida Sales Tax Number for location listed in (2)(a) (required): ________________________________________________________
   (e)  FEIN:  __________________________________________________________________________________________________________
   (f)   Telephone Number: ( ________ ) _________________________ Fax Number:( ________ )  __________________________________
   (g)  Name, address, position, and telephone number of person or persons to be contacted regarding this project. (Form DR-835, 
    Power of Attorney, must be submitted if not an officer or employee of the business.)
    ________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________
2. (a)  Project Location (Address where the machinery and equipment will be or has been installed): 
    ________________________________________________________________________________________________________________
   (b)  Did you purchase or buy out another business at the location in 2.(a)?      Yes      No    If yes, when?_____________________
   (c)  Project Description (Explain in full detail the purpose and scope of work to be accomplished by the project.):
    ________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________
                                             (Attach additional sheet, if necessary)
   (d)  Is any qualifying machinery and equipment going to be leased?      Yes       No
    If yes, will this be a:     Capital Lease    Operating Lease   Please provide a complete, legible copy of the lease (If available).
   (e)  List the types of the major machinery and equipment that may be purchased or leased for the project. (DO NOT file a 
    separate application for each item of machinery and equipment to be purchased, if they are for the same project.)
    ______________________________________________________ _____________________________________________________
    ______________________________________________________ _____________________________________________________
    ______________________________________________________ _____________________________________________________
                                             (Attach additional sheet, if necessary)
   (f)  Total cost of the machinery and equipment to be purchased or leased for the project:  __________________________________
   (g)  Total cost of the entire project: ____________________________________________________________________________________
3. (a)  What is the product or item that will be made for sale by the machinery and equipment listed at the project location?
    ________________________________________________________________________________________________________________
   (b)  Is this product or a similar product already being made at the project location in 2.(a)?   Yes        No
   (c)  Is this product or a similar product already being made at another Florida location of this company?      Yes       No  If yes, 
    provide the location or locations: __________________________________________________________________________________
   (d)  Will production of the product in 3.(a) be closed down at a location listed in 3.(c), or has production been closed down?
      Yes      No  If yes, when will or did production at that location stop?  ______________________________________________
   (e)  What type of businesses or customers will be purchasing the product in 3.(a)? _________________________________________
    _______________________________________________________________________________________________________________

 SECTION II 
If claiming exemption as a new business, please answer the following:
1. Has this business previously applied for this exemption? If so, when? ____________________________________________________
2. (a)  Approximate Beginning and Completion Date of Construction (if construction is necessary):
        Beginning Date: ______________________________________        Completion Date:  ______________________________________
   (b)  Approximate Beginning Date of Machinery and Equipment Purchases: _________________________________________________
   (c)  Estimated Start Date of Production:  _______________________________________________________________________________

 SECTION III
If claiming exemption as an expanding business, please answer the following:
1. Has this business previously applied for this exemption? If so, when? ____________________________________________________
2. (a)  Approximate Beginning and Completion Date of Construction (if construction is necessary): 
        Beginning Date: ______________________________________        Completion Date:  ______________________________________
   (b)  Approximate Beginning Date of Installation of Machinery and Equipment Purchases:  ____________________________________
   (c)  Estimated Date of Completion of Machinery and Equipment Installation: ________________________________________________
3. Please answer the following regarding productive output for your expansion project.
   (a)  Specfy the unit of measure that you will use to measure your increase in productive output; i.e., pounds, tons, pieces,
        gallons, cubic yards, sheets, etc. (Selling price or labor hours cannot be used.) _______________________________________
        ________________________________________________________________________________________________________________
   (b)  What is your expected percent increase in productive output following the expansion project? ____________________________%
 ADDITIONAL REMARKS

    ___________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________

Important: A qualifying business entity must file this form whether it seeks to make purchases of machinery and equipment 
           tax-exempt or seeks a refund of previously paid taxes.  To avoid any delays in obtaining the permit or a refund, the 
           application must be fully completed and returned to the Department of Revenue.  A business that seeks a refund 
           of previously paid tax must file an Application for Refund - Sales and Use Tax (Form DR-26S) within the applicable 
           statutory limits.  See s. 215.26(2), F.S. For additional information, call (850) 617-8346.

                                                                     _______________________________________    ________________
Mail this form to:
                                                                    Signature                              Date
DIRECTOR
TECHNICAL ASSISTANCE AND DISPUTE RESOLUTION                         __________________________________________________________
FLORIDA  DEPARTMENT OF REVENUE                                      Print Name
PO BOX 7443                                                         __________________________________________________________
TALLAHASSEE FL 32314-7443                                           Title

                                 For Florida Department of Revenue use ONLY — Do not write in this space.
The above project is: (check one)
      Approved as a new business                                   Permit _________________________        _____________________________
      Approved as an expanding business                                           From                                     To
      Approved as a spaceport activity
      Approved as a mining activity                                   Permit Number ________________________________________________
      Not approved for the exemption                                  Refund                               No Permit Issued

Business Name:   _________________________________________________ _________________________________________________________________
                                                                    (Signature of Authorized Agent)                             Date
Sales Tax Number:  _______________________________________________