Free DR-350907 - Florida

Local Insurance Premium Tax Special Fire Control Districts Notification of Jurisdiction Change
Mail to: LOCAL GOVERNMENT UNIT FLORIDA DEPARTMENT OF REVENUE PO BOX 6530 TALLAHASSEE FL 32314-6530

DR-350907 R. 10/06

All jurisdiction change requests must be submitted via the Department of Revenue's Internet site at http://geotax.state.fl.us. Competent evidence for the jurisdiction change described below must be submitted with this form. Changes submitted without filing this form and the proper documentation will not be considered for modification of the address/jurisdiction database.
Name of Fire Control District initiating change Effective date of change NOTE: Changes must be provided by September 3rd each year. Case number Type of jurisdiction change NOTE: The case number is assigned by the Department's address database once

change records are submitted. The database is available at http://geotax.state.fl.us

Street address correction

New address Yes No

Annexation

Other _____________________

Does this change affect another local jurisdiction?

If yes, enter affected jurisdiction ___________________________________

OFFICIAL AUTHORIZATION
Part A Initiating jurisdiction Name of authorizing official Title Telephone E-mail
I have reviewed the proposed jurisdiction changes for accuracy. I am an authorized representative of the Florida jurisdiction requesting these changes. I authorize the Department of Revenue to modify the address/jurisdiction database to reect these changes.

Part B Affected jurisdiction Name of authorizing official (See Instructions - Step 4.) Title

Fax

Telephone E-mail

Fax

I have reviewed the proposed jurisdiction changes for accuracy. I am an authorized representative of the Florida jurisdiction affected by these changes. I authorize the Department of Revenue to modify the address/jurisdiction database to reect these changes.

Signature ________________________________________________________ Date _____________________________________________________________

Signature ________________________________________________________ Date _____________________________________________________________

Part C. Complete this part only if you are unable to obtain the written consent of the affected jurisdiction. Affected jurisdiction Method of contact (check all that apply) Telephone Mail Name of authorizing official contacted

E-mail

Fax

Other

I have contacted the authorizing official named above and have been unable to obtain a signature in Part B. Signature of authorized representative of initiating jurisdiction _____________________________________________________________________________

FOR DOR USE ONLY Date Received ___________________________ Worked By ______________________________ Action _________________________________

DR-350907 R. 10/06 Page 2

Instructions for Completing Form DR-350907 Who must use this form?
Special Fire Control Districts participating in the Local Insurance Premium Tax associated with a Firefighters' Pension Trust Fund under Chapter 175, Florida Statutes must use Form DR-350907 to notify the Department of Revenue (DOR) of jurisdiction changes. Note: All jurisdiction change requests must be submitted via the Department of Revenue's Internet site at http://geotax.state.fl.us. Competent evidence for the jurisdiction change must be submitted with this form. Section 175.101(1) Florida Statutes states that the local insurance premium tax is imposed only on policies covering property "within the corporate limits of such municipalities or within the legally defined boundaries of special fire control districts, respectively". Changes submitted online without filing this form and the proper competent evidence attachments will not be considered. Step 4. Obtain authorization. If the change to the database affects only your jurisdiction, complete Part A of the Official Authorization section. If the change affects a participating municipality or another Special Fire Control District participating in providing pension benefits to firefighters as provided under Chapter 175 Florida Statutes, complete Parts A and B. To facilitate processing of address database changes, the local jurisdiction requesting the change should attempt to obtain the written consent of the affected jurisdiction (signature in Part B). The name of the authorizing official should be the address database contact person for that jurisdiction. Participating Special Fire Control Districts can access a list of contact persons on the internet at http://www.myflorida.com/dor/taxes/ipt_contacts.pdf Special Fire Control Districts can also call the Department's Local Government Unit at 850-921-9181 for this information. Complete Part C only if you have attempted to obtain the signature of the authorizing official and have been unable to do so. Step 5. Attach competent evidence to this form. Mark each piece of evidence with the online case number. Some examples of competent evidence are: · Plat · Ordinance · Survey · Annexation approval · Map · Permit(s) Step 6. Submit Form DR-350907 (with competent evidence attached ) to DOR. Mail to: Florida Department of Revenue Local Government Unit PO Box 6530 Tallahassee, FL 32314-6530 For overnight or other delivery requiring a street address, use: Florida Department of Revenue Local Government Unit 5050 W. Tennessee St. Bldg E-1 Tallahassee, FL 32304-9201 Or Fax to: 850-921-4711 (Suncom 291-4711) For more information, call the Department's Local Government Unit at 850-921-9181 (Suncom 291-9181) or e-mail to: [email protected] Persons with hearing or speech impairments may call the TDD line at 800-367-8331 or 850-922-1115 (Suncom 292-1115).

How to submit jurisdiction changes
Step 1. Set up online access. Obtain your access code for the online address/jurisdiction database from DOR. Log on to the database at http://geotax.state.fl.us and establish your profile. Step 2. Submit changes online. After reviewing the current address/jurisdiction database, submit your jurisdiction changes either by using the online entry screen or batch process. When the changes are successfully submitted, you will receive a case number. All jurisdiction changes must be submitted to DOR via the online database, unless otherwise approved. Step 3. Complete Form DR-350907. Enter the name of the jurisdiction initiating the change and the effective date of the change. Changes must be provided by September 3rd each year. Enter the case number you received online. The case number is assigned by the Department's address database once change records are submitted. Check the box that corresponds to the type of jurisdiction change and indicate whether the change affects a municipality or another Special Fire Control District participating in providing pension benefits to firefighters as provided under Chapter 175 Florida Statutes. If the answer is "yes," enter the name of the municipality or Special Fire Control District in the space provided.