Fillable Request for Copy of Tax Return (Florida)

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Request for Copy of Tax Return (Florida)

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DR-841
R. 07/15
TC
Rule 12-22.005
Florida Administrative Code
Effective 07/15
Request for Copy of Tax Return
This form is used to request a copy of any tax return filed with the Florida Department of Revenue.
Section 1: Taxpayer Information
Taxpayer Name:
Florida Tax Registration Number:
Street or Mailing Address:
City:
Email Address:
Federal Employers Identification Number (FEIN): Social Security Number (SSN)*:
State:
ZIP:
Telephone Number:
Fax Number:
Representative Name:
Street or Mailing Address:
City:
Email Address:
State:
ZIP:
Telephone Number:
Fax Number:
Section 2: Taxpayer Representative - This section is to be completed when a taxpayer representative will be receiving the records
requested. A signed Power of Attorney and Declaration of Representative (Form DR-835) must be attached.
Section 3: Return(s) Requested
Amusement Machine Certificate Fee
Communications Services Tax
Corporate Income Tax
Documentary Stamp Tax
Estate Tax
Fuel Tax
Government Leasehold (Intangible) Tax
Gross Receipts Tax on Dry Cleaning
Gross Receipts Tax on Utility Services
Insurance Premium Taxes and Fees
Miami-Dade Lake Belt Mitigation Fees
Motor Vehicle Warranty Fee
Oil Production Tax
Pollutants Tax
Reemployment Tax (formerly Unemployment Tax)
Rental Car Surcharge
Sales and Use Tax
Solid Minerals Severance Tax
Solid Waste Fees (Tires/Batteries)
Florida Business Tax Application
From:
To:
Tax Return Type: (select all that apply)
From:
To:
From:
Date of Death:
From:
To:
From:
To:
From:
Additional Information on Return(s) Requested:
To:
Decedent's SSN*:
To:
From:
From:
To:
To:
To:
From:
To:
From:
To:
From:
To:
From:
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From:
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From:
Section 4: Delivery - Indicate whether the tax return(s) is to be delivered to the taxpayer or to the taxpayer's representative. Select only one method
of delivery. If you select email, select whether to receive the email using a secure email system or through an unsecure email system.
Recipient of Tax Return(s):
Method to Provide Tax Return(s):
I authorize the Department to send the requested tax return(s) using the Florida Department of Revenue's secure email. I understand that this method
requires additional steps to view the tax return(s) provided.
I authorize the Department to send the requested tax return(s) using an unsecure email to the address indicated. I acknowledge that the tax return(s)
may be viewed by someone other than the taxpayer or taxpayer representative indicated.
Authorization and Signature
I authorize the release and delivery, as indicated in this request, of the confidential information contained in the above-described tax return(s).
Request for Copy of Tax Return Instructions
This form is used to request a copy of any tax return filed with the Florida Department of Revenue.
General Instructions
Your privacy is important to the Department. To protect your privacy, access to personal information about you is limited to individuals
authorized by law to have access to that information. To ensure that information is not provided without your consent, a written request from
you is required before the Department will provide tax returns to anyone.
Section 1 - Taxpayer Information
To protect the privacy of your business information, the information entered in this section must be the same as the taxpayer information
maintained by the Department.
Section 2 - Taxpayer Representative
Complete this section only if the tax return(s) requested will be provided to an authorized representative. You must attach a completed and
signed Form DR-835, Power of Attorney and Declaration of Representative, authorizing the representative to receive the tax return(s).
Section 3 - Return(s) Requested
Indicate the tax return(s) and the filing period(s) that you need.
Section 4 - Delivery
Indicate the method by which you wish to receive the tax return(s) - email, fax, or mail. If you indicate email, unless you authorize the
Department to send your tax return(s) using an unsecure email, the Department will send the requested return(s) using its secure email
software. This software will require additional steps before you can access your return(s). If you choose to receive the tax return(s) by
unsecure email, they will be sent to the email address that you provided. Remember that unsecure emails may be accessed or viewed by
someone other than the intended recipient.
Authorization/Signature
You must sign this request if you are the taxpayer requesting the tax return(s) or if you are authorized by the taxpayer to receive the taxpayer's
tax return(s). The Department cannot process your request without your signature or without you authorizing the release of the tax
information contained in the requested tax return(s).
Fax or mail this request to the address below. If the requested return(s) will be delivered to an authorized representative, include a
completed and signed Power of Attorney.
Records Management, MS 1-5730
Florida Department of Revenue
5050 W. Tennessee Street
Tallahassee FL 32399-0158
Fax: 850-922-5936 or 850-922-0861
If you have questions or need assistance completing this form, call us at 850-488-6800.
*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's taxes. SSNs obtained for tax administration purposes are confidential under
sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection of your SSN is authorized under state and federal law. Visit our Internet site at www.floridarevenue.com and
select "Privacy Notice" for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions.
Taxpayer Signature
Representative Signature
OR
Date
Date
DR-841
R. 07/15
Page 2
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Request for Copy of Tax Return (Florida)

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Completed 28 June 2021

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