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:
            ACCOUNT MANAGEMENT - MS 1-5730                                                                                      THIS AREA FOR DOR USE ONLY
            FLORIDA DEPARTMENT OF REVENUE                                                                                       PERMIT NO. ________________________________
            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

                                 Information and Instructions for Completing                                        DR-16A
                                                                                                                    R. 01/15
                     Application for Self-Accrual Authority / Direct Pay Permit                                         Page 2
                                                    Sales and Use Tax

Section (s.) 212.183, Florida Statutes (F.S.), allows the Department to authorize certain sales tax dealers to pay directly to 
the Department.  Qualifying entities will be issued a direct pay permit to provide to their suppliers instead of paying sales 
tax on authorized purchases or leases.  Only one permit is required for all of your business locations.
> Complete Part I.                                               • The purchase of tangible personal property by dealers who 
> Complete Part II by reviewing the self-accrual authority         annually purchase at least $100,000 of taxable tangible 
  categories and checking the category that qualifies your         personal property, including maintenance and repairs for the 
  business for a direct pay permit.                                dealer’s own use, when the taxable status of such property 
> Complete and sign Part III.  Incomplete or unsigned              will be known only upon its use. The taxable status of the 
  applications will be returned.                                   property will be known upon its use when the dealer’s 
> If you are a common carrier and are applying under the           normal trade or business characteristics require the dealer to 
  apportionment category, you must attach a copy of your           purchase tangible personal property that will either become 
  letter of authority from the U.S. Department of Transportation   a component part of a product manufactured for sale or will 
  (DOT).                                                           be used and consumed by the dealer.
> Mail or deliver your completed application to:
  ACCOUNT MANAGEMENT - MS 1-5730                                 Promotional Materials (PRO)
  FLORIDA DEPARTMENT OF REVENUE                                  • The purchase of promotional materials, as defined in 
  5050 W TENNESSEE ST                                              s. 212.06(11)(b), F.S., by dealers who are unable to determine 
  TALLAHASSEE FL  32399-0160                                       at the time of purchase whether the promotional materials 
                                                                   will be used in Florida or exported from Florida only when 
Self-Accrual Categories – Sales and Use Tax                        the seller of promoted subscriptions to publications sold in 
                                                                   Florida is a registered dealer and is remitting sales tax to 
Apportionment (APP)                                                the Department on publications sold in Florida. The dealer 
• The apportionment of tax by eligible air carriers for the        purchasing and distributing promotional materials and the 
  purchase or use of tangible personal property, as provided in    seller of the promoted subscriptions to publications are not 
  s. 212.0598, F.S.                                                required to be the same person.
• The partial exemption applicable to vessels and parts thereof 
  used in interstate or foreign commerce for the purchase of     Real Property Leases (RPL)
  vessels and parts thereof, as provided in s. 212.08(8), F.S.,  • The lease or license to use real property subject to tax under 
  and Rule 12A-1.064, Florida Administrative Code (F.A.C.).        s. 212.031, F.S., by dealers who are required to remit sales 
• The partial exemption applicable to railroads and parts          tax electronically, as provided under s. 213.755, F.S., from a 
  thereof used in interstate or foreign commerce by licensed       number of independent owners or lessors of real property.
  railroad carriers for purchases of tangible personal property, • The lease or license to use real property subject to the tax 
  as provided in s. 212.08(9)(a), F.S., and Rule 12A-1.064,        imposed under s. 212.031, F.S., by a dealer who leases 
  F.A.C.                                                           or obtains licenses to use real property from a number of 
• The partial exemption applicable to motor vehicles and parts     independent property owners who, except for the lease or 
  thereof used in interstate or foreign commerce by licensed       license to the dealer, would not be required to register as 
  common carriers, as provided in s. 212.08(9)(b), F.S., and       dealers engaged in the business of leasing real property.
  Rule 12A-1.064, F.A.C.                                         • The lease or license to use real property subject to the tax 
                                                                   imposed under s. 212.031, F.S., by operators of amusement 
Purchases of Tangible Personal Property (TPP)                      machines or vending machines who lease or obtain licenses 
• The purchase of tangible personal property by dealers            to use real property from property owners or lessors for the 
  who annually purchase in excess of $10 million of taxable        purpose of placing and operating an amusement or vending 
  tangible personal property in any county for the dealer’s own    machine.
  use.
                                                            Contact Us

  If you need more information or have questions, call             Information, forms, and tutorials are available on our website: 
  Taxpayer Services at 850-488-6800, Monday through                floridarevenue.com
  Friday (excluding holidays).
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      5050 W TENNESSEE ST                                               workshops, and more.
      TALLAHASSEE FL 32399-0112
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