DR-18N
                                                                                                              N. 01/16
                         Application for Amusement Machine Certificate                                        TC 03/22
                                                                                                  Rule 12A-1.097, F.A.C.
                                                                                                         Effective 01/16
                                General Information and Instructions

A Coin-Operated Amusement Machine is any machine            the certificate’s expiration date. If you do not receive a 
operated by coin, slug, token, coupon, or similar           renewal notice, you may use this application to renew 
device for the purpose of entertainment or amusement.       your annual amusement machine certificates. Be sure to 
Amusement machines include: coin-operated radios            check the box “Annual Renewal Application.”  
and televisions, telescopes, pinball machines, music 
                                                            Who is Required to Purchase and Display Amusement 
machines, juke boxes, mechanical rides, video games, 
                                                            Machine Certificates? The amusement machine operator 
arcade games, billiard tables, shooting galleries, and all 
                                                            responsible for removing the receipts from the machine 
other similar amusement devices.
                                                            and paying sales tax and applicable surtax on the 
Purpose of this Application.  This application is used      machine receipts is required to purchase and display the 
to obtain an annual Amusement Machine Certificate           Amusement Machine Certificates (DR-18C). 
(DR-18C) for each location where you operate one or  
                                                            When the business owner, where the machines are 
more coin-operated amusement machines.  The annual 
                                                            located, is the owner of the amusement machines, the 
fee is $30 per machine.  To complete this application, 
                                                            business owner is the amusement machine operator 
you must have an active sales and use tax Certificate 
                                                            and the person required to purchase and display the 
of Registration (Form DR-11) for each county in which 
                                                            Amusement Machine Certificates.
the machines are operated.
                                                            The business owner where the amusement machines are 
If you do not have a sales tax number for each county 
                                                            operated is considered to be the operator and required 
where your machines are located for operation, you can 
                                                            to purchase the Amusement Machine Certificates, even 
register to collect and report tax through our website at: 
                                                            when the business is not the owner of the machines. 
floridarevenue.com. The site will guide you through an 
                                                            However, the operator responsibilities may be otherwise 
application interview that will help you determine your tax 
                                                            specified in a written agreement between the business 
obligations. If you do not have Internet access, you can 
                                                            owner and the amusement machine owner.
complete a paper Florida Business Tax Application (Form 
DR-1).                                                      How is the Certificate Fee Calculated? The annual 
                                                            certificate fee is $30 for each machine times the maximum 
If you wish to operate more machines at any location 
                                                            number of machines operated at that location. Certificates 
than the number currently listed on your Amusement 
                                                            are valid for a period of one year, July 1 to June 30. The 
Machine Certificate for that location, you must complete 
                                                            annual fee is non-refundable and cannot be prorated 
another application and pay $30 for each additional 
                                                            based on the time of year the certificate is purchased.
machine.
                                                            Where Do I File the Application and Required Fee?  
If you move your amusement machines from one 
                                                            This application and the required $30 per machine fee 
location to another location within the same county, 
                                                            may be delivered to the nearest Florida Department of 
contact the Department to correct the machine location 
                                                            Revenue service center or mailed to the address below. 
on your certificates.  If you move your amusement 
                                                            Make your check (U.S. funds only) or money order 
machines to another county, you must first have a sales 
                                                            payable to the Florida Department of Revenue.
and use tax Certificate of Registration in that county 
before contacting the Department to update the machine 
location on your certificates.                              Amusement Machine Certificate
Your amusement machine certificate expires on               Florida Department of Revenue
June 30th each year. You must renew amusement               PO Box 5500
machine certificates before that date.  A renewal notice    Tallahassee FL 32314-5500
containing information on your Amusement Machine 
Certificates will be mailed to you 30 to 60 days before 

                                                                                           DR-18N
                                                                                           N. 01/16
                                                                                           Page 2

Contact Us   
Information, forms, and tutorials are available on our website: floridarevenue.com   

To speak with a Department representative, call Taxpayer Services at 850-488-6800, Monday through Friday 
(excluding holidays).  

To find a taxpayer service center near you, go to: floridarevenue.com/taxes/servicecenters 

For written replies to tax questions, write to: 
       Taxpayer Services  - MS 3-2000 
       Florida Department of Revenue 
       5050 W Tennessee St  
       Tallahassee FL 32399-0112     

Get the Latest Tax Information  
Subscribe to our tax publications to receive due date reminders or an email when we post: 
 •     Tax Information Publications (TIPs). 
 •     Proposed rules, notices of rule development workshops, and more.    

Go to: floridarevenue.com/dor/subscribe

                           Application for Amusement Machine Certificate                                                         DR-18
                                                                                                                                 R. 01/16
                                                                                                                                 TC 03/22
                                            q Initial Application                                         Rule 12A-1.097, F.A.C.
                                                                                                                         Effective 01/16
                                            q Add Locations or Machines  
                                            q Annual Renewal Application
  
 Amusement Machine Operator Information: 
 Business Partner Number - This number is located          Business Operator Identification Number - Provide the Federal 
 on the back of your Certificate of Registration           Employer Identification Number (FEIN) of the business operator or 
 (Form DR-11).                                             Social Security Number (SSN)* of the operator.

 Business Partner Number:                                  FEIN:                              SSN*:

 *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 Internet site at:         
 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.

 Name of operator _____________________________________________________________________________________________
 Business name of operator  ____________________________________________________________________________________
 Operator’s mailing address_____________________________________________________________________________________
 City _______________________________________________ State _________________________ ZIP _______________________
 Telephone Number: ( ______) _____________________  Email Address:  ______________________________________________
 (Your email address is treated as confidential information [section 213.053, Florida Statutes], and is not subject to 
 disclosure of public records [section 119.071, Florida Statutes].)

 Under penalties of perjury, I certify that I have read this application and the facts stated in it are true.  I understand that 
 a new certificate must be obtained and additional fees are due if I wish to operate more amusement machines than are 
 authorized by the certificates issued under this application.

 ________________________________________________________________                        ______________________________
 Authorized signature of operator or operator’s authorized representative                   Date
 ________________________________________________________________
 Print or type the signature above
 This application and the required $30 per machine fee may be delivered to the nearest Florida Department of Revenue 
 service center or mailed to:
     Amusement Machine Certificate                               Note: Your check or money order is for the total amount of
     Florida Department of Revenue                               machine fees for all locations ($30 times the total number
     PO Box 5500                                                 of machines). If not, your application and payment will be
     Tallahassee FL 32314-5500                                   returned to you without processing.
 Be Sure To:
                                                                 Amusement Machine Location Information
 •  Indicate the type of application you are submitting:
                                                                 Enter your county or location sales and use tax Certificate 
     › Initial Application  › Adding locations or machines 
                                                                 of Registration number for this location. If this is your first 
                › Annual Renewal Application
                                                                 application for a certificate for machines operated at this 
 •  Obtain a sales and use tax Certificate of                    location, check the box for “New Location.”  If you are adding 
     Registration number for each county in which you            machines to a previously issued certificate, check the box for 
     will operate amusement machines before you                  “Change Amusement Machine Certificate” and enter the 
     complete this application.                                  number of additional machines that will be operated at this 
 •  If you have a consolidated sales tax account, be             location.  If you did not receive a renewal application from the 
     sure to enter your county sales tax certificate             Department and you are using this application to renew your 
     number for the county in theAmusement Machine               certificate, check the box “Annual Renewal. ”        Be sure to 
     Location Information, not your consolidated sales           enter the maximum number of machines to be operated 
     tax account number.                                         at each location. Multiply the number of machines by $30 to 
                                                                 compute the fee due for each location.

                                                     For DOR office use only
  No. of locations:  ________  No. of machines:  ________  Amount paid:  ___________ Processed by: ____________  Date: ______________

                                                                                                                    DR-18
This page may be photocopied to provide additional location information.  Front page must always be included.       R. 01/16
                                                                                                                    Page 2

LOCATION # 1  Sales Tax Certificate Number for the location county:
                             (You must provide an active sales tax number for this county.)    _________  -   _______________________________ -  ______

Location Business Name ______________________________________________________________________________________
Physical street address (Do not use PO Box) _____________________________________________________________________
City ______________________________ County ______________________ State ____________________ ZIP ________________
Maximum number of machines to be operated at this location: 
Check One:
q  New Location ...........................................................Total number of machines        x $30 = $
q  Annual Renewal .......................................................Total number of machines          x $30 = $
q  Change Amusement Machine Certificate ..................... Additional machines                          x $30 = $

LOCATION # 2  Sales Tax Certificate Number for the location county:
                             (You must provide an active sales tax number for this county.)    _________  -   _______________________________ -  ______

Location Business Name ______________________________________________________________________________________
Physical street address (Do not use PO Box) _____________________________________________________________________
City ______________________________ County ______________________ State ____________________ ZIP ________________
Maximum number of machines to be operated at this location: 
Check One:
q  New Location ...........................................................Total number of machines        x $30 = $
q  Annual Renewal .......................................................Total number of machines          x $30 = $
q  Change Amusement Machine Certificate ..................... Additional machines                          x $30 = $

LOCATION # 3  Sales Tax Certificate Number for the location county:
                             (You must provide an active sales tax number for this county.)    _________  -   _______________________________ -  ______

Location Business Name ______________________________________________________________________________________
Physical street address (Do not use PO Box) _____________________________________________________________________
City ______________________________ County ______________________ State ____________________ ZIP ________________
Maximum number of machines to be operated at this location: 
Check One:
q  New Location ...........................................................Total number of machines        x $30 = $
q  Annual Renewal .......................................................Total number of machines          x $30 = $
q  Change Amusement Machine Certificate ..................... Additional machines                          x $30 = $

LOCATION # 4  Sales Tax Certificate Number for the location county:
                             (You must provide an active sales tax number for this county.)    _________  -   _______________________________ -  ______

Location Business Name ______________________________________________________________________________________
Physical street address (Do not use PO Box) _____________________________________________________________________
City ______________________________ County ______________________ State ____________________ ZIP ________________
Maximum number of machines to be operated at this location: 
Check One:
q  New Location ...........................................................Total number of machines        x $30 = $
q  Annual Renewal .......................................................Total number of machines          x $30 = $
q  Change Amusement Machine Certificate ..................... Additional machines                          x $30 = $

Summary of Fee(s) Paid
Total Number of Machines on this Application: __________  X $30  =  $ _____________________
                                                                                                      (total fee remitted with application)