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Company ID Here
Florida Corporate Short Form F-1120A, R. 01/22
Rule 12C-1.051
Income Tax Return Florida Administrative Code
For tax year beginning on or after January 1 Effective 01/22
Make checks payable and mail to:
FLORIDA DEPARTMENT OF REVENUE, 5050 W TENNESSEE STREET, TALLAHASSEE FL 32399-0135
If you are requesting a refund (Line 9b), send your return to:
FLORIDA DEPARTMENT OF REVENUE
PO BOX 6440
TALLAHASSEE FL 32314-6440
PERF LINE--------------------------------------------------------------------------------
Florida Corporate Short Form Income Tax Return Company ID Here
F-1120A, R. 01/22
Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief, it is true, correct, and complete. If prepared by
a person other than the taxpayer, the declaration is based on all information of which the preparer has any knowledge.
Signature of Officer Date Contact Email Address Phone
Signature of Individual or Firm Preparing the Return Date Preparer’s PTIN or FEIN (Check one) Phone
FEIN Taxable Year Beginning___/___/___ Taxable Year Ending ___/___/___
Name FDOR - Corporate Test
Address 5050 W Tennessee Street
City/State/ZIP Tallahasse, Fl 32399-0141 DOR USE ONLY
___/___/___
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