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111 Iiil ill I II III Il II VIII I II Ilii II III II C Florida+ Department of Revenue Employer's Quarterly iReport U4 R <br /> e 01 /11 <br /> QUARTER ENDING PMPLOYER S NAME JT ACCOUNT NUMBER <br /> IP EMPLOYEE'S SOl SECURITY NUMBER 11 EMPLOYEES NAME ;flreasewmerstof asi game am 4s; 123EMPLOYEESGROSS 'NAG€S PAID THIS QUARTER <br /> eg4n cnaracrae :I mst rame 'n xxms 12b. EMPLOYEES TAXABLE WAGES PAID THIS QUARTER <br /> ;nay +ne • "it S; 600 naa 'o pXra `Xi ter -,uantlr rrxtz 5 '3x3de <br /> 12.7. <br /> de^,a n 1 a 12b. <br /> `lar^u 12a. <br /> rr;. <br /> 12b. <br /> 12a. <br /> •u�.a . , "i 12b. <br /> mss. <br /> ^dar,A - 12a. <br /> ..,r r a. 12b. <br /> _ Ar <br /> :r ,m. <br /> 12b. <br /> 1Gt _ <br /> .. v�,r•n 12a. <br /> w . .a . .. .. a 12b. <br /> + <br /> 12b. <br /> , <br /> va--`• r • 3I 12b. <br /> 13a. Total Gross Wages [add Lanes 12a only) Total this page only '. <br /> irdiude !his and totals from additional pages at Line 2 on page 1 , 7, 7 , <br /> L 13b Total Taxable Wages land Lines 12b only) Total this page only <br /> Irclune this and totals fmm additional pages in Line a on page ' ! <br /> DO NOT <br /> . . DETACH .. .. . . .. . . . . . . . . . . . . .. . . . . <br /> Mail Reply To: Social security numbers (SSNs) are used by the Florida Department of Revenue as unique <br /> Unemployment Tax dentifiers for the administration of Florida's taxes. SSNs obtained for tax administration <br /> Florida Department of Revenue purposes are confidential under sections 213.053 and 119. 071 , Flonda Statutes, and not <br /> 5050 W Tennessee St Bldg L Subject to disclosure as public records. Collection of your SSN is authorized under state <br /> Tallahassee FL 32399- 0180 and federal iaw. Visit our Internet site at www.myflorida.com/dor and select " Privacy <br /> Notice" for more Information regarding the state and federal law governing the collection, <br /> use, or release of SSNs, Including authorized exceptions. <br /> Tired of paperwork? We can help ! <br /> File and pay your Florida unemployment tax online. <br /> It's fast , easy, accurate , and secure . <br /> Inlernei Address: www.myflonda.eom/dor <br /> - 13 - <br />