Get Exempt Organizations Attestation Of Direct Billing State - Floridahospices

Filling out the Exempt Organizations Attestation of Direct Billing State - Floridahospices can be a straightforward process if you follow a clear set of instructions. This guide will walk you through the necessary steps to complete the form accurately, ensuring that your organization can take advantage of its exempt status.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the representative's details. This includes printing the name and title of the individual filling out the form.
3. Fill in the name of the exempt organization you represent. Ensure that this matches the official name of the organization for accuracy.
4. Indicate the type of exempt entity, such as governmental or nonprofit organization.
5. Enter the Exempt Entity Consumer’s Certificate of Exemption number (Form DR-14) and its expiration date.
6. Provide the address, phone number, and email contact information of the exempt entity. Make sure all contact details are correct and current.
7. For the billing period, enter the dates during which the purchase, lease, or rental was made. This should reflect the exact period for which the claims of exemption apply.
8. If applicable, provide the name and address of the hotel or other entity where services were rendered or accommodations were rented.
9. Read through the attestation statement carefully. Confirm that all information provided is truthful and that the charges will be paid directly by the exempt organization.
10. Authorize the form by signing on behalf of the exempt entity and dating the signature. Ensure that everyone involved understands the importance of accuracy in this declaration.
11. Once all sections are filled out and reviewed, save your changes and proceed to download, print, or share the completed form as needed.

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