Free DR-700022 - Florida

Notification of Jurisdiction Change for Local Communications Services and Local Insurance Premium Tax
Mail to: LOCAL GOVERNMENT UNIT FLORIDA DEPARTMENT OF REVENUE PO BOX 6530 TALLAHASSEE FL 32314-6530

DR-700022 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 jurisdiction initiating change Effective date of change (check only one) January 1, _______ July 1, _______ Case number Type of jurisdiction change County

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 Disincorporation

New address Reorganization Yes No

Annexation 911 change

Incorporation 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-700022 R. 10/06 Page 2

Instructions for Completing Form DR-700022 Who must use this form?
Local governing authorities must use Form DR-700022 to notify the Department of Revenue (DOR) of local government jurisdiction changes. Pursuant to sections 175.1015, 185.085 and 202.22, Florida Statutes, each jurisdiction shall furnish the Department with all the information necessary to update the address/jurisdiction database. Special fire control districts must use Form DR-350907 to submit jurisdiction changes, and cannot use Form DR-700022. 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. Competent evidence to support a change to the address/ jurisdiction database is documentation establishing that the addresses affected by the requested change or addition are located in the local taxing jurisdiction indicated on the request. Changes submitted online without filing this form and the proper attachments will not be considered. Local taxing jurisdictions that do not have access to computers with Internet access should contact the Department to request authorization to submit changes through alternative electronic media. Step 4. obtain authorization. If the change affects only your jurisdiction, complete Part A of the Official Authorization section. If the change affects another jurisdiction, 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. Local governments can access a list of contact persons on the database site at http://geotax.state. fl.us. For a list of local Insurance Permium Tax contacts go to www.myflorida.com/dor/taxes/ipt_contacts.pdf. All others should 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-700022 (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 by using the online entry screen or batch process. If your city is participating in the local insurance premium tax for the firefighters' pension fund, include the appropriate fire district information when adding addresses. 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-700022. Enter the name of the jurisdiction initiating the change, the county, and the effective date of the change. Changes must be provided 120 days prior to the effective date indicated. 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 another local jurisdiction. If the answer is "yes," enter the name of the jurisdiction in the space provided.