Florida Department of Agriculture and Consumer Services



Florida Department of Agriculture and Consumer Services

Office of Energy

Florida Renewable energy technologies

ADAM H. PUTNAM

COMMISSIONER

Sales tax refund Application

Rule 5O-2.001, Florida administrative Code

Applications must be received by certified mail or hand delivery by the Florida Department of Agriculture and Consumer Services, Office of Energy, 600 South Calhoun Street, Suite 251, Tallahassee, Florida 32399-0001, no later than close of business on June 30, 2016.

|Applicant | |

|Registered Agent, Officer, or Director | |

|Street Address | |

|Mailing Address (if different) | |

|County | |

|Contact Person | |

|Phone Number | |

|FEIN/Tax ID Number | |

|Total 6% Florida Sales Tax Paid | |

Under penalty of perjury, I swear that the information contained in the application and supporting documentation is true and correct, that all itemized equipment, machinery, and other materials has not previously received a Florida sales tax refund, and that the requirements of Section 212.08(7)(hhh), Florida Statutes, and Rule 5O-2.001, Florida Administrative Code, have been met.

_________________________ _________________________ _________________

Signature of Applicant/Representative Printed Name and Title Date

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|FOR OFFICAL USE ONLY – To be completed by the Office of Energy. |

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|Total Amount of Florida Sales Tax to Be Refunded: |

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|_________________________ _________________________ _________________ |

|OOE Authorizing Signature Printed Name and Title Date |

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|Date Certification Sent to Applicant/Taxpayer: |

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|Date Certification Sent to the Florida Department of Revenue: |

PROJECT SUMMARY: Provide a summary that describes how the costs itemized below are being used in connection with the distribution of biodiesel (B10-B100), ethanol (E10-E100) or other renewable fuels including the fueling infrastructure, transportation, and storage. The project summary must include the location of the materials and any other relevant information. Additional pages may be attached.

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DETAIL SHEET: Provide an itemized list of materials for which the applicant is seeking a Florida Renewable Energy Technologies Sales Tax Refund. Additional pages may be attached.

|FUELING infrastructure |

|Page Number(s) |Invoice Number |Invoice Date |6% FL Sales Tax Paid|Serial Number or Other |Payment Date |Description of Cost |

| | | | |Identification | | |

| | | | | | | |

| | | | | | | |

|Subtotal for Fueling | |

|Infrastructure | |

|TRANSPORTATION | | | | |

|Page Number(s) |Invoice Number |Invoice Date |6% FL Sales Tax Paid|Serial Number or Other |Payment Date |Description of Cost |

| | | | |Identification | | |

| | | | | | | |

| | | | | | | |

|Subtotal for Transportation | |

|STORAGE |

|Page Number(s) |Invoice Number |Invoice Date |6% FL Sales Tax Paid|Serial Number or Other |Payment Date |Description of Cost |

| | | | |Identification | | |

| | | | | | | |

| | | | | | | |

|Subtotal for Storage | |

|TOTAL 6% FLORIDA SALES TAX PAID | |

SUPPORTING DOCUMENATION: Attach the sales invoice and corresponding proof of purchase showing the amount of Florida sales tax accrued and paid, the date of purchase, and the name and address of the dealer, as defined in Section 212.06, F.S., from whom the property was purchased for each eligible cost listed above. All invoices and corresponding proof of payments must be numbered. Applications must include an explanation if the amounts on the invoice and corresponding proof of payment do not match. Legible copies of the documents, in place of originals, will be accepted. If the Florida Department of Agriculture and Consumer Services, Office of Energy, determines the supporting documentation is illegible, the application will be determined incomplete.

ADDITIONAL INSTURCTIONS: Applicants must submit with the completed application a description of the economic impact in Florida as described in Rule 5O-2.001(5), Florida Administrative Code.

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