Free DR-1S - Florida

Application for Secondhand Dealer or Secondary Metals Recycler Registration

DR-1S R. 07/08
Rule 12A-17.005 Florida Administrative Code Effective 09/08

Instructions for Completing Form DR-1S
A secondhand dealer or secondary metals recycler may not engage in business at any location without registering with the Department of Revenue. In addition to completing Form DR-1S, new applicants must undergo a background investigation. Go to www.myflorida.com/dor/forms to order a registration package (GT-200405) that contains all the required registration materials. Typically, orders are delivered within three to five days. You must complete a separate Form DR-1S for each business location. Failure to submit all required forms will delay processing of your application. Note: A business that engages in "pawnbroker" activities or title loan transactions does not need to register as a secondhand dealer with the Department of Revenue. Pawnbrokers should register with the Florida Department of Agriculture and Consumer Services and title loan companies should register with the Florida Department of Banking and Finance. Registration Fees: The registration fee is $6.00 for each location. If you are registering as a secondhand dealer and a secondary metals recycler, you must include fees for both registrations ($12.00). Also, each applicant must undergo a background investigation and submit the appropriate fees.

Background Investigation Requirements
Every applicant seeking registration as a secondhand dealer or secondary metals recycler is required to undergo a background investigation. This includes corporations, sole proprietorships, partnerships, joint ventures, and any other type of business entity.

Each owner, officer and partner must provide a completed fingerprint card and a full-face photograph with this application. Each director with the ability to control the business and stockholder with a controlling interest must also provide a completed fingerprint card and a full-face photograph with this application. A director with no ability to control the company may submit a letter signed by an active principal corporate officer (president, vice-president, secretary, or treasurer) attesting that the director in question is not required to submit to a background investigation because he or she is not an owner of any interest, financial or otherwise.

Every applicant must use an FBI fingerprint card and have it completed by a local law enforcement offical. If you did not receive a fingerprint card or need additional cards, you can order them from the Department's Internet site. Go to www.myflorida.com/dor/forms to order additional FBI fingerprint cards (GT-200406). Background Investigation Fees: A background investigation fee must be paid for each owner, officer, partner, or stockholder or director with a controlling interest. For fee amounts, refer to the cover letter that accompanied this form or call the Department. The background investigation fee may be included with the registration fee. Make your check payable to the Florida Department of Revenue. Mail the application, fingerprint cards, full-face photographs, and fees to: Account Management - Secondhand Dealer Unit Florida Department of Revenue PO Box 6480 Tallahassee FL 32314-6480

For Information and Forms
Information and forms are available on our Internet site at

www.myflorida.com/dor
To speak with a Department of Revenue representative, call Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m., ET, at 800-352-3671. Persons with hearing or speech impairments may call our TDD at 800-367-8331 or 850-922-1115.

For a written reply to tax questions, write: Taxpayer Services Florida Department of Revenue 1379 Blountstown Hwy Tallahassee FL 32304-2716 To receive forms by mail: · Order multiple copies of forms from our Internet site at www.myflorida.com/dor/forms or · Mail form requests to: Distribution Center Florida Department of Revenue 168A Blountstown Hwy Tallahassee FL 32304-3761

DR-1S R. 07/08 Page 2

Application for Secondhand Dealer or Secondary Metals Recycler Registration
1. This application is for a: Secondhand Dealer 2. Secondary Metals Recycler This application is for a (check one): New business ­
3. Legal name of corporation, individual owner, limited liability company, partnership, or other: Owner telephone number:

Additional location ­

List current secondhand dealer registration number

(
4. Trade or fictitious name (d/b/a) (if different than #3 above):

) ) )

Business telephone number:

** Please Type or Print Clearly**

(
5. Complete physical address of business. Home-based businesses and non-permanent flea market/craft show vendors must use your home address. Listing a post office box, private mailbox, or rural route number is not permitted. Street: City/State/ZIP: County:

Fax number:

(

6. Contact name (business owner or designee):

Contact telephone number:

(
Mailing address (if different than physical address): Street: City/State/ZIP: E-mail address:

)

7.

Is your business registered to collect sales and use tax? If yes, enter your sales and use tax certificate number:

Yes ­

No ­

8.

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. a. b. Federal Employer Identification Number (FEIN): or Social Security Number (SSN) of owner: ­ ­ ­
(If you are required to have an FEIN but have not yet been assigned one, you may call the Internal Revenue Service at 800-829-4933 to request one.)

FOR DOR USE ONLY
Approved Denied By: (User ID) Date month day year

Business Partner No. Contract Object (LO)

DR-1S R. 07/08 Page 3 9. Type of ownership and legal organization (check one): Sole proprietorship - An unincorporated business that is owned by one individual. Partnership - The relationship existing between two or more entities or individuals who join to carry on a trade or business. This includes a business jointly owned/operated by a husband and wife. Check one: General partnership Limited partnership Joint venture Married couple Corporation - A person or group of people who incorporate by receiving a charter from their state's Secretary of State (includes professional service corporations). Check one: C-corporation S-corporation Not-for-profit corporation Limited liability company - Two or more entities (or individuals) who file articles of organization with their state's Secretary of State. Check one: Single-member LLC Multi-member LLC Check here if you elected to be treated as a corporation for federal income tax purposes. 10. If the business is a partnership, corporation, or limited liability company, provide your fiscal year ending date:
month day

11a. If the business is incorporated, chartered or otherwise registered to do business in Florida, provide your document/registration number from the Florida Secretary of State: ________________________________________________________________________ Provide the date of incorporation, charter, or authorization to do business in Florida:

Note:
If you are not incorporated, chartered or registered to do business in Florida, you may be required to do so. For more information, go to the Florida Department of State's Internet site at www.sunbiz.org or call 850-488-9000.

month

day

year

11b. If the business is incorporated in another state, provide the name of the state: ___________________________________________ 12. If the business is a corporation, provide the resident agent's contact information: Resident agent's name: _________________________________________________________________________________________ Resident agent's street address: _________________________________________________________________________________ Resident agent's City/State/ZIP: _________________________________________________________________________________ Resident agent's telephone number (include area code) _____________________________________________________________ 13. Personnel/Partner Information: Provide the full name, title, FEIN or SSN (if an FEIN is not required for your business entity, the SSN of the owner is required), and address and telephone number of each corporate officer, owner, general partner, stockholder and/or director with a controlling interest. Make copies of this page if additional space is needed.
SSN or FEIN Street address City/State/ZIP or Foreign Country/Postal Code Telephone number

Name Title

(___)___-____ (___)___-____ (___)___-____ (___)___-____

DR-1S R. 07/08 Page 4

All applicants MUST answer Questions 1 through 7.
1. Are you a secondhand dealer as defined in section 538.03(1), F.S.? A secondhand dealer engages in the business of purchasing, consigning, or trading secondhand goods from a fixed location. ........................ Yes No 2. Are you a secondary metals recycler as defined in section 538.18, F.S.? A secondary metals recycler has facilities for performing the manufacturing process by which ferrous metals or nonferrous metals are converted into raw material products consisting of prepared grades and having an existing or potential economic value, other than by the exclusive use of hand tools, by methods including, without limitation, processing, sorting, cutting, classifying, cleaning, baling, wrapping, shredding, shearing, or changing the physical form or chemical content thereof. .. Yes No 3. Do you agree to comply with the record keeping requirements of Chapter 538.04, F.S. (secondhand dealers) or Chapter 538.19, F.S. (secondary metals recyclers)? ..................................................................... Yes No 4. Do you agree to allow for inspection of your records, property, and premises as required by Chapter 538.05, F.S. (secondhand dealers) or Chapter 538.20, F.S. (secondary metals recyclers)? ........................................ Yes No 5. Do you agree to comply with the holding period requirements as provided in Chapter 538.06, F.S. (secondhand dealers) or Chapter 538.21, F.S. (secondary metals recyclers)? ........................................ Yes No 6. Has your business paid all the sales and use tax owed to the Department of Revenue as required by s. 538.09, F.S. (secondhand dealers) or 538.25, F.S. (secondary metals recyclers)? .................................................... Yes No 7. Are you 18 years or older? ........................... Yes No

Secondhand dealers MUST answer Questions 8, 9, and 10. Secondary metals recyclers should skip to Question 11.
8. Within the preceding 10 years, have you or other owners, officers, partners, directors or stockholders with a controlling interest been convicted of, or entered into a plea of guilty or nolo contendere to, a crime committed against the laws of this state or any other state or of the United States involving theft, larceny, dealing in stolen property, receiving stolen property, burglary, embezzlement, obtaining property by false pretenses, possession of altered property, any felony drug offense, any violation of s. 812.015, F.S., or any fraudulent or dishonest dealing? .................................................................... Yes No

9. Have you ever made a misrepresentation or false statement to, or concealed any essential or material fact from, any person in making a purchase or sale of secondhand goods? ..................................................................... Yes No 10. Have you ever had a final judgment entered against you in civil action upon grounds of fraud, embezzlement, misrepresentation, or deceit? ....................... Yes No

Secondary metals recyclers MUST answer Question 11.
11. Within the preceding 24 months, have you or other owners, officers, partners, directors or stockholders with a controlling interest been convicted of, or entered a plea of guilty or nolo contendere to, a felony committed against the laws of the state or of the United States involving theft, larceny, dealing in stolen property, receiving stolen property, burglary, embezzlement, obtaining property by false pretenses, possession of altered property, or any felony drug offense or of knowingly or intentionally violating the laws of the state? ......................................... Yes No

Applicant Signature -- This application cannot be processed if not signed by an owner, officer, partner, director or stockholder with
a controlling interest. Under the penalties of perjury, I declare that I have read this application and that the facts stated in it are true. [ss. 92.525(2), 538.09, 538.25, and 837.06, Florida Statutes]

___________________________________________________________________________ Signature of Applicant

____________________________________ Title

_________________ Date