Florida Application for Tax Credit Allocation for Contributions to Nonprofit Scholarship Funding Organizations (SFOs) R.01/20

Application for Tax Credit Allocation for Contributions to Nonprofit Scholarship Funding Organizations (SFOs) R.01/20
Form DR-116000
Florida Tax Credit Scholarship Program
Application for Tax Credit Allocation for Contributions to
Nonprofit Scholarship-Funding Organizations
Business Name:

DR-116000
R. 01/25

Rule 12-29.003, F.A.C.
Page 1 of 2

Federal Employer Identification Number (FEIN):

Business Address:

City, State, ZIP:

Contact Person Name:

Telephone Number:

Email Address*:

*Your privacy is important to the Florida Department of Revenue. Email addresses provided to the Department for tax
administration purposes are confidential and exempt from disclosure under section 213.053(2), F.S.
Florida Law requires you to authorize the Florida Department of Revenue to respond to you using unencrypted email that does not
require additional steps before you can access information in the email. To expedite the processing of your application, you may wish to
receive unencrypted email regarding this application. If so, indicate your approval to receive unencrypted email by selecting ‘Yes’ below,
otherwise, select ‘No.’
o Yes. I authorize the Florida Department of Revenue to send information regarding this application using unencrypted email.
o No. I wish to receive encrypted emails from the Florida Department of Revenue. (The software used to encrypt email requires a
one-time passcode or a user account.)
Enter the nonprofit scholarship-funding organization (SFO) to which the
contribution will be made.
A separate application is required for each organization.

Name of SFO:

Total amount of planned contribution:

$

Indicate the amount of credit allocation for each applicable tax. The sum of the amounts must equal the planned contribution amount
entered above.
$

Corporate Income Tax

Beginning Date
of Tax Year:

$

Insurance Premium Tax

Prior Calendar
Year: MM/DD/YYYY

$

Excise Tax on Malt
Beverages

For the Fiscal Year beginning July 1,

Excise Tax on Wine
Beverages

For the Fiscal Year beginning July 1,

Excise Tax on Liquor
Beverages

For the Fiscal Year beginning July 1,

Sales and Use Tax due
from a Direct Pay
Permit Holder

For the Fiscal Year beginning July 1,

$

Tax on Oil Production

For the Fiscal Year beginning July 1,

YYYY

$

Tax on Gas Production

For the Fiscal Year beginning July 1,

YYYY

$

$

$

MM/DD/YYYY

or

Ending Date of
Tax Year:

MM/DD/YYYY

Current Calendar Year: MM/DD/YYYY

YYYY

Malt Beverage License Number:
YYYY

Wine Beverage License Number:
YYYY

Liquor Beverage License Number:
YYYY

Sales Tax Certificate Number:

DR-116000
R. 01/25
Page 2 of 2

If you file a consolidated Florida corporate income tax return, you must provide the parent corporation’s name and FEIN.
Parent corporation:

Parent corporation’s FEIN:

I understand that section (s.) 1002.395(5)(b)2., Florida Statutes (F.S.), requires the Florida Department of Revenue to provide a copy
of any approval or denial it issues with respect to this application to the nonprofit scholarship-funding organization indicated in this
application.
Under penalty of perjury, I declare that I have read this application and that the facts stated in it are true.
________________________________________________ 	
Signature of officer, owner, or partner

_________________________________
Date