Florida Application for Rescindment of Tax Credit Allocation for Contributions to Nonprofit Scholarship Funding Organizations (SFOs) R.07/11

Application for Rescindment of Tax Credit Allocation for Contributions to Nonprofit Scholarship Funding Organizations (SFOs) R.07/11
DR 116100 R. 01-19.indd
Florida Tax Credit Scholarship Program
Application for Rescindment of Previous Allocation of Tax Credit
(Under sections [ss.] 211.0251, 212.1831, 220.1875, 561.1211, 624.51055,
and 1002.395, Florida Statutes, [F.S.])

DR-116100
R. 01/19

Rule 12-29.003, F.A.C.
Effective 01/19
Page 1 of 2

Business name____________________________________________________________________________________________
–

Federal Employer Identification Number (FEIN)

Mailing address___________________________________________________________________________________________
City ___________________________________________ State _____________ ZIP___________________________________
Contact person ___________________________ Contact’s telephone number _____________________________________
Contact person's email address ____________________________________________________________________________
If included in a consolidated Florida corporate income tax return, provide:
Parent Corporation’s FEIN

–

Original amount of planned contribution $

,

,

.

Confirmation number of original credit allocation application __________________________________________________
Enter the name of the SFO the credit was originally approved for:
_________________________________________________________________________________________________________
Enter the amount you wish to rescind $

,

,

.

Enter the amount(s) below to rescind based on the tax type. (The sum of the amounts by tax cannot exceed the total
amount you wish to rescind above. The amount to be rescinded for each tax cannot exceed the amount allocated to
that tax on the original application.):
	

______________ Corporate Income Tax (Chapter 220, F.S.)

	

______________ Insurance Premium Tax (s. 624.509, F.S.)

	

______________ Excise Tax on Malt Beverages (s. 563.05, F.S.)

	

______________ Excise Tax on Wine Beverages (s. 564.06, F.S.)

	

______________ Excise Tax on Liquor Beverages (s. 565.12, F.S.)

	

______________ Sales Tax Paid by a Direct Pay Permit Holder (s. 212.183, F.S.)

	

______________ Tax on Oil Production (s. 211.02, F.S.)

	

______________ Tax on Gas Production (s. 211.025, F.S.)

I understand that section (s.) 1002.395(5)(f), 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 for rescindment to the nonprofit
scholarship-funding organization indicated on the associated application for an allocation of credit.
Under penalty of perjury, I declare that I have read this application form and that the facts stated in it are true.
________________________________________________ 			
	
Signature of officer, owner, or partner

______________________
Date

DR-116100
R. 01/19
Page 2 of 2

Instructions for Completing Form DR-116100
You may apply to the Department for rescindment of all or
part of a previously approved allocation of tax credit under
the Florida Tax Credit Scholarship Program using the
Department's website at
floridarevenue.com/taxes/sfo. You must submit
a separate application for the rescindment of each
previously approved credit allocation.

The Department will send written correspondence
regarding the approved rescindment amount or the reason
the rescindment request could not be approved.

Once you have entered the requested information, a
confirmation screen with a confirmation number will
appear. This screen will display the information entered
and confirm receipt of the electronic application for
rescindment. You can print this screen or simply record
the confirmation number to prove that you submitted an
application for rescindment.

(2)	 The allocation year is closed for all taxpayers.
The allocation for a particular year is closed for
all taxpayers on October 1st of the third year
after the January 1 opening of the allocation
period. For example, the allocation year beginning
January 1, 2018, for the state fiscal year
beginning July 1, 2018, closes for all taxpayers on
October 1, 2020, regardless of whether the annual
allotment has been reached because October 1, 2020,
is the extended due date of the last tax year beginning
in the 2018 calendar year (tax year beginning
December 1, 2018, and ending November 30, 2019,
with a due date of April 1, 2020, and extended due
date of October 1, 2020).

If you don't have your original confirmation number
contact the Revenue Accounting section at 850-617-8586.

The Department will approve the rescindment unless:
(1)	 You have claimed the credit amount to be rescinded
on a previously filed tax return.