Questionnaire - DOR Seller Permit ONLY

BAKER LAW, P.A.

Questionnaire for:

Dept. of Revenue Business Tax Application and Resale Certificate

Please type or print clearly and answer all questions as completely as possible to avoid processing delays.

Responsible Person Name:

Contact Person Email:

Phone:

Business Anticipated Opening Date:

Applicant/Entity Name:

D/B/A:

**Have you registered the DBA with the FL Div. of Corporations and published it pursuant to F.S. 865.09?

Yes

N/A – Not using DBA

Entity Federal Employer Identification Number (EIN):

Business Location Address:

Mailing Address (if different):

Business Email:

Business Phone:

Is this business location only open during a portion of a calendar year?

Yes

If yes, provide the first and last calendar months the business location is open:

Did you file an S-Corp Election for the business?

Yes

How many owners does the company have?

If your business is a corporation or LLC, provide the date of FL incorporation or organization:

Fiscal Year Ending Date (generally December 31st):

List below ALL persons and entities in the entire ownership structure. Ownership percentage must total 100%.

Name

Title

Address

Driver’s License State and No

Social Security No.

Ownership Percentage

Describe the primary nature of your business and the types of products or services to be sold or offered. Include in your description whether products will include food, hemp/CBD, alcohol, tobacco or other regulated products.

BAKER LAW, P.A.

BAKER LAW, P.A.

Questionnaire for:

Dept. of Revenue Business Tax Application and Resale Certificate

Please type or print clearly and answer all questions as completely as possible to avoid processing delays.

List below ALL persons and entities in the entire ownership structure. Ownership percentage must total 100%.

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CONTACT

THE FIRM

JONATHON W. BAKER, ESQ.

ATTORNEY-AT-LAW