DR-602G
                                                                                                                                                                                        R. 01/16
                                                 Governmental Leasehold                                                                                                                      TC
                                                                                                                                                                    Rule 12C-2.0115
                                              Intangible Personal Property Tax                                                                             Florida Administrative Code
                                                                                                                                                                       Effective 01/16
                            Application for Extension of Time to File Return
                                                                                                                                             Taxable year:      Y   Y                   Y   Y
                                                                                                                                                                                            
Taxpayer should complete Section  A  and Section  C                     Federal Employer
                                                                        Identification Number:  _________________________________________________
    Section A    (To be completed by taxpayer)
In order to expedite your request for an extension of time to file your Social Security Number
return, we need your Federal Employer Identification Number (FEIN).     (if no FEIN):  ___________________________________________________________

                                                                        Business Partner #:  ____________________________________________________

                                                                        Contract Object #:   ____________________________________________________
                                                                                                               Social security numbers are used by the Florida Department of 
                                                                                                               Revenue as unique identifiers for the administration of Florida’s taxes.  
                                                                                                               Social security numbers 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 
Name: ____________________________________________________                                                     is authorized under state and federal law.  Visit our Internet site at 
                                                                                                               www.floridarevenue.com and select “Privacy Notice” for more information 
Address: __________________________________________________                                                    regarding the state and federal law governing the collection, use, or 
                                                                                                               release of SSNs, including authorized exceptions.
                                                                                                                                            US DOLLARS                   CENTS
____________________________________________________
                                                                                                               Tax Due
City: _____________________ State: ________  ZIP: ______________                                                                     ,           ,                                      t 
                                                                                                                                      Check here if you transmitted funds electronically

           Section B (To be completed by the Department of Revenue)

              1.  Your application for extension has been denied due to late filing.  Your application was 
                  postmarked or signed after the original due date of June 30.

              2.  Other (Explanation)

                                            Date                                                               Name and Title

                                              Mail entire application to:
                                              Florida Department of Revenue
                                              5050 W Tennessee St
                                              Tallahassee FL 32399-0100
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                                                  Governmental Leasehold
Section C     (To be completed by taxpayer)      Intangible Personal Property Tax                                                                                      DR-602G
                                              Application for Extension of Time to File Return                                                                          R. 01/16

                                                                                                             In order to expedite your request for an extension of time to file your 
                                                                                                             return, we need your Federal Employer Identification Number (FEIN).
                                                                                                               Contract Object # 
                                                                                                               (if available)                                                            
              DR-602G                                                   Federal Employer 
                                                                        Identification Number                                                                                              
Name
Address                                                                 Social Security Number 
                                                                        (if no FEIN)                                                                                                       
City/St/ZIP
                                                                                                                                             Taxable year:      Y   Y    Y                  Y
                                                                                                                                                                                           
                                                                                                                                            US DOLLARS                   CENTS
    Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this 
    application, and that to the best of my knowledge and belief the statements herein are true and correct:   Tax Due
                                                                                                                                      ,          ,                                      t 
    Sign here:___________________________________________Date:__________________                                                      Check here if you transmitted funds electronically

                                                 9100 0 99999999 0018015006 5 9999999999 0000 0

                                                                                                                        DR-602G
                                                                                                                        R. 01/16

                               INSTRUCTIONS FOR FILING FORM DR-602G

Who May File -  This application is to be used by a taxpayer   Discount Periods - An extension of time may not be used to 
to request an extension of time to file a governmental         extend the discount periods.
leasehold tax return.
                                                               Penalties -  No penalty will be assessed if the return is filed 
When to File -  Your application for extension must be         and taxes are paid during the extension period.
filed on or before June 30 of the tax year.  Applications 
                                                               Failure to file the return  orpay the tax due within the 
postmarked after this date will be denied regardless of 
                                                               extended time (by September 30) will result in the 
whether June 30 falls on a Saturday, Sunday or state or 
                                                               assessment of penalties from the due date (June 30) until the 
federal holiday.
                                                               date the return is filed and the tax is paid.
How to File - For each return required to be filed, a separate 
                                                               The penalties are:
application for extension of time must be filed. Blanket 
requests for extensions of time for filing more than one       1) A delinquency penalty of 10% per month or portion of a 
return will not be granted.                                    month not to exceed 50% of the tax due.
Where to File - Submit applications for extension of time to:  2) A specific late-filing penalty of 10% per month or portion of 
Florida Department of Revenue                                  a month, until the return is filed, not to exceed a maximum 
5050 W Tennessee St                                            of 50% of the tax due.
Tallahassee FL 32399-0100
                                                                 *The combined total of the delinquency penalty and 
How Your Extension of Time Will Affect Your Tax                specific late filing penalty cannot exceed 10% per 
Return - An extension of time will be granted for filing the   month or portion of a month, not to exceed a maximum 
return or reporting and paying the tax due required under      of 50% of the tax due.
Chapter 199, F.S.  The extension covers penalty only.  
                                                               Interest - A floating rate of interest applies to underpayments 
Interest is due on tax not paid on or before June 30.  You 
                                                               and late payments of tax.  The rate will be updated January 1 
will be notified by the Department of Revenue only if the 
                                                               and July 1 of each year by using the formula established in 
extension is denied.
                                                               s. 213.235, F.S.
Tax Rate - The tax rate is .0005, or 1/2 mill per $1,000.
                                                               Signature - The form must be signed by the taxpayer, a 
Length of Extension - The return and payment must be           partner, an officer of the corporation, or a person authorized 
postmarked on or before September 30 to avoid penalty.         by the taxpayer.
The extension period will not be extended if September 30 
falls on a weekend or holiday. 

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