DR-654
                                            Request for Waiver from Electronic Filing                                              R. 01/13
                                                                                                                                                          TC
                                                                                                                                   Rule 12-24.011
                                                                                                                                   Florida Administrative Code
                                                                                                                                   Effective 05/13

Business partner or 
Tax account number:  ____________________________________________                Type of tax: ___________________________________

Business name: _________________________________________________                 FEIN or SSN: __________________________________

Contact person: _________________________________________________                Phone number: ________________________________

Contact address: ________________________________________________                Fax number: __________________________________

                  ________________________________________________               E-mail address: ________________________________
Some taxpayers are not able to file electronically for various reasons.  Please answer these questions to help us decide if you 
        Sample 
can use our system.
1.  Does your business currently file information electronically with other businesses or government agencies?  [     ]  yes     [     ]  no
2.  Does your business have a computer with a 486/66-MHz processor or higher?  [     ]  yes     [     ]  no
3.  Does your business have access to the Internet?  [     ]  yes     [     ]  no
4.  Do you use programmers, software developers, or service providers who are not your employees to calculate, report, or pay
    this tax?  [     ]  yes     [     ]  no
                 If yes, what is the person’s/company’s name: ___________________________________________________________
      I have attached a letter containing more information on why I should be allowed to file paper returns.
                 or
      I have not attached a letter containing more information on why I should be allowed to file paper returns.
Read  Formthe statements below and initial each line to indicate you understand each statement and provide the requested 
information on questions one and two.
1.  ___  I understand that if my waiver is approved and I am allowed to file paper returns, this waiver may be good for up to two
        years.  I want to file using paper returns until
                            /       /           .
                 M  M         D  D    Y  Y  Y  Y
2.  ___  I understand I still must pay electronically.
        a.          I have attached a completed DR-600 (Enrollment and Authorization for e-Services Program) and choose to pay
                    using the method checked below:
                             ACH Debit  or     ACH Credit.
                                   or
        b.          I am already enrolled to pay electronically.
3.  ___  I understand if my waiver is approved and I am allowed to file using paper returns, I must file using a Department-
        approved form.  I understand I will be charged penalties if I file my tax return using a form not approved by the 
        Department.
4.  ___  I understand I will not be allowed to file paper returns if I do not fill out this form completely and enroll to pay
        electronically (complete DR-600 if necessary).
5.  ___  I understand if I am approved to file using paper returns, my approval will not be retroactive.  I must contact the
        Department concerning any bills I have received or may receive for filing paper returns before I was approved to do so.
I, the undersigned, agree that the Department will return this request to me without processing the waiver if it is incomplete 
or contains inaccurate information.  I further agree that if I fail to submit a complete, accurate request at least 10 consecutive 
working days before my first electronic tax return is due to the Department, I will be required to submit such return 
electronically for such taxable period, since the Department will not have a sufficient period of time in which to process the 
waiver request.

___________________________________________________________  __________________________________________________________
        Print Name (Must be corporate officer or owner)                                                          Title

___________________________________________________________  __________________________________________________________
                              Signature                                                                          Date
Complete and mail this form to:                                      Social Security Numbers
Account Management Mail Stop 1-5730          Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the 
Florida Department of Revenue                administration of Florida’s taxes.  SSNs obtained for tax administration purposes are confidential under sections 
5050 W Tennessee St                          213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records.  Collection of your SSN is 
Tallahassee, FL 32399-0160                   authorized under state and federal law.  Visit our Internet site at floridarevenue.com and select “Privacy Notice” 
Fax 850-488-5997                              for more information regarding the state and federal law governing the collection, use, or release of SSNs, 
                                                                     including authorized exceptions.