Documentary Stamp Tax Return For Nonregistered Taxpayers' Unrecorded Documents This return is for nonregistered taxpayers only and is due no later than the 20th of the month following the execution month. SEE INSTRUCTIONS ON REVERSE SIDE. Rule 12B-4.003 Florida Administrative Code Effective 01/16 DR-228 R. 01/16 TC Filing Tips ü DO NOT attach original or copies of deeds or other documents to this return. ü Keep a copy of this return and a copy of your check for your records. Canceled check serves as your receipt of payment. ü Use Worksheet on reverse side to complete lines 4 ­ 8 on the tax return coupon below. ü DO NOT submit a photocopy of a DR-228 tax return. ü All documents listed must be executed and/or issued in the same month. A separate form must be completed for each month in which a document was executed and/or issued. ü Taxpayers with five or more taxable transactions per month must register with the Department. ü Complete all information requested on the coupon. ü Mail coupon to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0150 ü SIGN AND DATE THE RETURN. Florida Department of Revenue Documentary Stamp Tax Return For Nonregistered Taxpayers' Unrecorded Documents Taxpayer Name ________________________________________________________________________ Street Address ________________________________________________________________________ City/State/ZIP ________________________________________________________________________ County ____________________________________________ DR-228 R. 01/16 US Dollars 4. Miami-Dade County Surtax Due (from Step 5 of the worksheet) 5. Documentary Stamp Tax Due (from Step 6 of the worksheet) 6. Penalty (see instructions) 7. Interest (see instructions) Under penalties of perjury, I declare that I have examined this tax return and the facts stated in it are true. _________________________________________________________________ Signature of Taxpayer Ta yer pa x ________________ Date py Co - 8. Total Amount Due with Return (sum of Lines 4 through 7) FEIN SSN (if no FEIN) , , , , , Cents _____________________________________________ (_______) ____________________________ Title Phone Number (include area code) - Do Not Write in the Space Below 9100 0 20141225 0019025036 5 4000001189 2797 4 ***DETACH COUPON*** Florida Department of Revenue Documentary Stamp Tax Return For Nonregistered Taxpayers' Unrecorded Documents Taxpayer Name ________________________________________________________________________ Street Address ________________________________________________________________________ City/State/ZIP ________________________________________________________________________ County ____________________________________________ DR-228 R. 01/16 US Dollars 4. Miami-Dade County Surtax Due (from Step 5 of the worksheet) 5. Documentary Stamp Tax Due (from Step 6 of the worksheet) 6. Penalty (see instructions) 7. Interest (see instructions) 8. Total Amount Due with Return (sum of Lines 4 through 7) FEIN SSN (if no FEIN) Under penalties of perjury, I declare that I have examined this tax return and the facts stated in it are true. _________________________________________________________________ Signature of Taxpayer ________________ Date - , , , , , Cents _____________________________________________ (_______) ____________________________ Title Phone Number (include area code) - Do Not Write in the Space Below 9100 0 20141225 0019025036 5 4000001189 2797 4 American LegalNet, Inc. www.FormsWorkFlow.com Worksheet for Completing Form DR-228 Complete the information requested and carry subtotals to the front of this tax return. Step 1. Notes and Other Written Obligations to Pay Money ­ Tax-Rate: $.35 per $100 or fraction thereof. Florida law limits the maximum tax due on notes and other written obligations to $2,450. Example: A note of $252,150 is executed, signed, or delivered in Florida and no mortgage or other lien is filed or recorded in Florida. Tax calculation: 2,522 (taxable $100 units) x $.35 = $882.70. 1. Subtotal $.______________________________________ Step 2. Bonds ­ Tax-Rate: $.35 per $100 or fraction thereof. Example: A corporate bond in the amount of $100,000 is issued in Florida and no mortgage or other lien is filed or recorded in Florida. Tax calculation: 1,000 (taxable $100 units) x $.35 = $350.00. 2. Subtotal $.______________________________________ Steps 3a and 3b. Instruments Transferring Interest in Florida Real Property ­ Tax-Rate: $.70 per $100 of consideration or fraction thereof in all counties except Miami-Dade; Miami-Dade is $.60 per $100 and surtax of $.45 per $100 (on real property other than a single-family dwelling) of consideration or fraction thereof. Example: A deed transferring interest in unimproved real property (not a single-family dwelling) situated in Miami-Dade County is delivered for consideration of $535,750. Surtax calculation: 5,358 (taxable $100 units) x $.45 = $2,411.10. 3a. Surtax Subtotal $.______________________________________ Example 1: A deed transferring interest in real property situated in Miami-Dade County is delivered for consideration of $535,750. Tax calculation: 5,358 (taxable $100 units) x $.60 = $3,214.80. Example 2: A deed transferring interest in real property situated in any Florida county other than Miami-Dade is delivered for consideration of $404,105. Tax calculation: 4,042 (taxable $100 units) x $.70 = $2,829.40. 3b. Tax Subtotal $.______________________________________ Steps 4a and 4b. Instruments Transferring Ownership Interest in a Conduit Entity (see s. 201.02(1)(b), F.S., and Rule 12B-4.060, F.A.C.) ­ Tax-Rate: $.70 per $100 of consideration or fraction thereof in all counties except Miami-Dade; Miami-Dade is $.70 per $100 and surtax of $.45 per $100 (on real property other than a single-family dwelling held in the conduit entity) of consideration or fraction thereof. Example: An instrument transferring ownership interest in a conduit entity owning unimproved real property (not a single-family dwelling) situated in Miami-Dade County is delivered for consideration of $535,750. Surtax calculation: 5,358 (taxable $100 units) x $.45 = $2,411.10. 4a. Surtax Subtotal $.____________________________________ Example: An instrument transferring interest in real property situated in any Florida county, including Miami-Dade, is delivered for consideration of $535,750. Tax calculation: 5,358 (taxable $100 units) x $.70 = $3,750.60. 4b. Tax Subtotal $._________________