DR-15 1-2019 Iga
DR-15 1-2019 Iga
DR-15 1-2019 Iga
Original Return
FOR YOUR RECORDS ONLY - DO NOT MAIL
Cancellations must be done before 5:00 p.m. ET on the submission date. If the submission is completed
after 5:00 p.m. ET on the submission date, weekend, or holiday the cancellation must be done before 5:00
p.m. ET the next business day. All cancellations are permanently deleted from our database.
Due to federal security requirements, we can not process international ACH transactions. If any portion of the money
used in the payment you may be making today came from a financial institution located outside of the US or its
territories for the purpose of funding this payment, please do not proceed and contact the Florida Department of
Revenue at 850-488-6800 to make other payment arrangements. By continuing, you are confirming that this payment is
not an international ACH transaction. If you are unsure, please contact your financial institution.
I hereby authorize the Department of Revenue to process this ACH transaction and to debit the checking account
identified above. I understand there may be service charges assessed on any transactions not honored by my bank.
Signature: Neil Newman
Phone Number: 904-422-1931
EMail Address: newmann@bellsouth.net
15(a). Exempt Amount of Items Over $5000 (included in Column 3) 15(a). $ 0.00
15(b). Other Taxable Amounts NOT Subject to Surtax (included in Column 3) 15(b). $ 0.00
15(c). Amounts Subject to Surtax at a Rate Different than Your County Surtax Rate
15(c). $ 0.00
(included in Column 3)
15(d). Total Amount of Discretionary Sales Surtax Due (included in Column 4) 15(d). $ 2102.53
16. Hope Scholarship Credits (included in Line 6) 16. $ 0.00
17. Taxable Sales/Untaxed Purchases or Uses of Electricity
17. $ 0.00
(included in Line A)
18. Taxable Sales/Untaxed Purchases of Dyed Diesel Fuel
18. $ 0.00
(included in Line A)
19. Taxable Sales from Amusement Machines (included in Line A) 19. $ 0.00
20. Rural or Urban High Crime Area Job Tax Credits 20. $ 0.00
21(a). Scholarship Funding Tax Credit 21(a). $ 0.00
21(b). Film and Entertainment Industry Credit 21(b). $ 0.00
21(c). Economic Energy Zone Credit 21(c). $ 0.00
21 Other Authorized Credits 21. $ 0.00