DR-26 
                                       Florida Department of Revenue 
                                                                                                                         R. 01/19 
                                                                                                           Rule 12-26.008, F.A.C. 
                                                                                                           Effective 01/19 
                                              Application for Refund                                                     Page 1 of 2

Section 1: Taxpayer Information
 Taxpayer Name:

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

 Mailing Street Address:

 Mailing City:                         State:                                    ZIP:

 Location Street Address:

 Location City:                        State:                                    ZIP:

 Telephone Number (include area code): Fax Number (include area code):           Email Address (optional):

Section 2: Taxpayer Representative - This section is to be completed when a taxpayer representative is requesting the 
refund. A signed Florida Department of Revenue Power of Attorney and Declaration of Representative (Form DR-835) must be 
attached.
 Representative Name:

 Street or Mailing Address:

 City:                                 State:                                    ZIP:

 Telephone Number:                     Fax Number:                               Email Address (optional):

Section 3: Collection or Reporting Period(s) - Enter the date the tax was paid and the collection or reporting period(s).
 Date Paid (MM / DD / YY):                    Collection or Reporting Dates (MM / DD / YY to MM / DD / YY):

Section 4:  Tax Categories - Check the box next to the type of tax you paid.  A separate application must be completed for 
each tax type.
 Communications Services   Estate                         Insurance Premium                       Other (Please Specify):

 Corporate Income          Fuel                           Nonrecurring Intangible

 Documentary Stamp         Governmental Leasehold         Pollutant

 Section 5:  Refund Amount - Enter the refund amount.  Provide a brief explanation for the refund claim.
 Refund Amount:              Brief Explanation for Refund:

                                                                                                                                                     DR-26 
                                                                                                                                                     R. 01/19 
                                                                                                                                         Page 2 of 2

   *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 the Department's website at floridarevenue.com/privacy for more information regarding the state and 
   federal law governing the collection, use, or release of SSNs, including authorized exceptions.

   Authorization and Signature 
   Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true.

 Taxpayer Signature                                                                                 Date

 OR

Representative Signature                                                                            Date

        Mail this application and applicable documentation to:  
     
        Florida Department of Revenue                                                       For more information about the documentation 
        Refunds                                        OR                                      needed to process your refund, or to check on the 
        PO Box 6490                                        Fax 850-410-2526                         application status, call Refunds at 850-617-8585.
        Tallahassee FL 32314-6490  
    
                                                   Contact Us  

 Information, forms, and tutorials are available on the Department's website at floridarevenue.com. 
   
 To find a taxpayer service center near you, visit floridarevenue.com/taxes/servicecenters. 
   
 For written replies to tax questions, write to:  
      Taxpayer Services - Mail Stop 3-2000 
      Florida Department of Revenue 
      5050 W Tennessee St 
      Tallahassee FL 32399-0112 
   
 Subscribe to Receive Updates by Email from the Department. Subscribe to receive an email for due date reminders, Tax 
 Information Publications, or proposed rules. Subscribe today at floridarevenue.com/dor/subscribe.

                                                   Reference 
           The following document was mentioned in this form and is incorporated by reference in the rule indicated below. 
                                   The form is available online at floridarevenue.com/forms. 
                    Form DR-835       Florida Department of Revenue Power of Attorney                                        Rule 12-6.0015, F.A.C. 
                                      and Declaration of Representative