Laserfiche WebLink
DR-700218 <br /> R. 01 /11 <br /> I certify that all information is accurate and true to the best of my knowledge . I further certify that I will promptly Page <br /> 3 <br /> report to the Department of Revenue any changes in the above information . I also realize that failure to provide timely <br /> information required , allows the Department to utilize the best information available . If no such information is available , <br /> the Department will take necessary action including disqualification , either partial or entire , and you will waive your <br /> right to challenge the determination of the Department to your share of funds , if any , beyond your minimum entitlement , <br /> according to the privilege of receiving shared revenues from the Revenue Sharing Trust Funds . <br /> Do you believe that you have complied with ALL eligibility requirements as listed above ? <br /> F7 Yes No <br /> If the answer to question above is ( NO ) , please provide an attachment of the revenue necessary to meet your obligations <br /> because of pledges or assignments or trusts entered into which obligated funds received from revenue sharing . <br /> Signed : Date : <br /> Chief Fiscal Official <br /> o p moi,. <br /> Signed : ' pate : May 3 , 2011 <br /> a e Yk <br /> Bob Solari , Chairman <br /> o �ppp}•. � OQ. : <br /> Mail completed original appliress shown below. <br /> Florida Department of Revenue <br /> Revenue Accounting Subprocess <br /> PO Box 6609 <br /> Tallahassee , FL 32314-6609 <br /> 850 -617 -8586 <br /> REVENUEACCOUNTING@dor. state .fl . us <br />