VOTE RECORD FOR FINAL ADOPTION
OF MILLAGE LEVY
Section 200.065 (5), Florida Statutes
DR-487V
R. 6/10
Rule 12D-16.002
Florida Administrative Code
Effective 11/12
Counties, municipalities, independent special districts, water management districts, MSTUs, and dependent special districts must use
this form to certify the vote of the governing body on the millage rate adopted at their final hearing. The Department will use this
form to determine compliance with the maximum millage levy provisions.
Year : County :
Principal Authority : Taxing Authority :
Please list ALL members of the taxing authority governing body and their vote on the resolution or ordinance stating the millage rate
to be levied and adopted at their final hearing (s. 200.065(2)(d), F.S.). Depending on the size of the governing body, all lines may not
be needed.
Name
Yes No
Not Present or
Not Voting
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
S
I
G
N
H
E
R
E
Taxing Authority Certification
I certify the millages and rates are correct to the best of my knowledge. The millages comply
with the provisions of s. 200.065 and the provisions of either s. 200.071 or s. 200.081, F.S.
Signature of Chief Administrative Officer : Date :
Title :
Contact Name and Contact Title:
Attach additional sheets, if necessary. FINAL VOTE TOTALS :
Mailing Address :
Physical Address
City, State, Zip
Phone Number :
Fax Number :
This form must be submitted to the Department of Revenue with DR-487, Certification of Compliance,
and DR-420MM, Maximum Millage Levy Calculation Final Disclosure.
All TRIM forms for taxing authorities are available on our web site at
http://floridarevenue.com/property/Pages/TRIM.aspx
