
DR-700016
1. Tax due on sales subject to the state portion of the
communications services tax (from Summary of Sched. I, Col. F, Line 3) .... 1.
2. Tax due on sales subject to the gross receipts portion of the
communications services tax (from Summary of Sched. I, Col. G, Line 6) ... 2.
3. Tax due on sales subject to the local portion of the communications
services tax (from Summary of Sched. I, Col. H, Line 7) .............................. 3.
4. Tax due for direct-to-home satellite services (from Schedule II, Column C) 4.
5. Total communications services tax (add Lines 1 through 4) ......................... 5.
6. Collection allowance. Rate:________________ ......................................... 6.
(If rate above is blank, check one) ❑ None applies ❑ .0025 ❑ .0075
7. Net communications services tax due (subtract Line 6 from Line 5) ............ 7.
8. Penalty .......................................................................................................... 8.
9. Interest .......................................................................................................... 9.
10. Adjustments (from Schedule III, Column G and/or Schedule IV, Column U)10.
11. Multistate credits (from Schedule V) ........................................................... 11.
12. Amount due with return ............................................................................... 12.
Name
Address
City/State/ZIP
DR-700016
R. 12/01
To ensure proper credit to your account, attach your check
to this payment coupon and mail with tax return.
Payment Coupon DO NOT DETACH
Check here if your address or
business information changed
and enter changes below.
Check here if you are discontinuing your business
and this is your final return (see page 15)
Florida Communications Services Tax Return
DR-700016
R. 12/01
BUSINESS PARTNER NUMBER
9999 9 99999999 9999999999 9 9999999999 9999 9
Amount due
from Line 12
Business Address
Business Partner Number Reporting Period
Payment is due on the 1
st
and LATE
if postmarked or hand delivered after
Electronic Funds Transfer:
Check here if payment was transmitted electronically.
Under penalties of perjury, I hereby certify that this return has been examined by me and to the best of my knowledge and belief is a true and complete return. [ ss. 92.525(2),
203.01(1), and 837.06, Florida Statutes].
AUTHORIZATION
Type or print name Authorized signature Date
Preparer (type or print name) Preparer’s signature Date
Contact name (type or print name) Contact phone number
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11
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2 2
2
33
33
3
44
44
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5 5
5
66
66
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77
77
7
88
88
8
99
99
9
0123456789
Use black ink.
Handwritten Example Typed Example
Location/mailing address changes:
New location address: ______________________________________
_________________________________________________________
_________________________________________________________
Telephone number: (______)__________________________________
New mailing address: ________________________________________
_________________________________________________________
_________________________________________________________
US Dollars Cents
DOR USE ONLY
postmark or hand delivery date
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FEIN
FROM:
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REPORTING PERIOD
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