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Account name:

Account number:

Property address:


Property owner

First name:

Last name:

Phone number:

Email:

Address:

City/APO/FPO:

State/Province:

Zip/Postal code:

Country:


Status change details

Effective date of change:

Change to make to the above account:

If you chose Inactivate, select a reason:

Property has been sold (complete the section below)

Date of sale:

New owner
Name:

Address:

City/APO/FPO:

State/Province:

Zip/Postal code:

Country:

No longer renting permanently as of (date)

No longer renting transiently (all units are rented with written leases longer than six months)

Other

Comments:


Acknowledgement of status change request

Your name:

Your title:

Any person who acts knowingly and with a willful intent to evade any tax imposed or fails to file six consecutive returns as required by law commits a felony of the third degree, punishable as provided in Florida Statute 775.082 or 775.083. Ref. Florida Statute 212.12(2)(c).