DR-1CON 
                                                         Application for Consolidated                                                   R. 01/16 
                                                                                                                                                                                       TC 
                                      Sales and Use Tax Filing Number                                                                   Rule 12A-1.097 
                                                                                                             Florida Administrative Code 
                                                                                                                                        Effective 01/16

If you own multiple business locations within a single county or in multiple counties, and would like to make a single tax payment for 
all locations, complete this application to obtain a consolidated sales and use tax number.  All business locations must be owned by 
the same entity with the same Federal Employer Identification Number (FEIN).  A separate application is required for each entity with 
a separate FEIN.  If you choose this reporting method, you must e-file your tax returns and pay the tax due electronically.  For 
more information on how to e-file and e-pay tax, visit the Department's website at: www.floridarevenue.com

 Section 1 - Taxpayer Information (Please provide all information requested below.)
Owner Name (individual, principal partner, or corporate name):

Business Name (business, trade, or fictitious (d/b/a) name):

Business Partner Number:                                 Federal Employer Identification Number (FEIN):     Social Security Number (SSN)*:

Mailing Address (address where you want to receive correspondence):

City:                                                    County:        State:                               ZIP:

Contact Person:                                                         Telephone Number:

Email Address:                                                          Fax Number:

Section 2 - Sales and Use Tax Certificate Numbers to be Consolidated 
(All accounts must have the same FEIN.)

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Section 3 - Effective Date of Consolidation 
(This date must be the first day of a calendar month.)                                                  /   /

Under penalties of perjury, I declare that I have read the information provided in this application and the facts stated in it are true.

 Signature of Business Owner, Principal Partner, or Corporate Officer   Date

 Print or Type the Name Signed Above                                    Title

Email the completed application to: acctmaint@floridarevenue.com 
Mail this completed application to: 
Account Management, MS 1-5730 
Florida Department of Revenue  
5050 W Tennessee Street 
Tallahassee, FL 32399-0160 
 
* Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's taxes.  SSNs obtained for tax administration 
purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records.  Collection of your SSN is authorized under state and 
federal law.  Visit our website at www.floridarevenue.com and select “Privacy Notice” for more information regarding the state and federal law governing the collection, use, or release of 
SSNs, including authorized exceptions.