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III III ) IIIIIIIIIIIIIVIIIIIIIIIIIIIIIII L Florida10 qUal <br /> Entub u4 Jt fI IentofReveneEmployer's QuaterlyReport <br /> J R 01/1111 <br /> QUARTER ENDING EMPLOYER'S NAME UT ACCOUNT NUMBER <br /> I <br /> ....... ...... <br /> 11 . EMPLOYEE'S NAME ,please print first twelve characters of last name and first 12a. EMPLOYEE 'S GROSS WAGES PAID THIS <br /> QUARTER <br /> 10 EMPLOYEE S SOCIAL SECUF31TY NUMBER eight ht characters of fust name in boxes) i 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS <br /> QUARTER <br /> I Only the first E7 000 paid to ea& employee per calendar years taxab e. I <br /> 1.... <br /> � I. L <br /> 12b. 1 <br /> 1 i 1 L 1 12a, IL 9 Il <br /> J <br /> _ <br /> Initial ' t � 12b. <br /> i <br /> lln � L 12a. <br /> ho 11 12b. <br /> a �.._.� 1211a. �..... <br /> - y ::___ <br /> Nan <br /> Initial 12b. <br /> �...... f ;1 f <br /> a I ,�. I 1 , r rO [ <br /> Initial (. _...� 12b. <br /> 12a.ilt dole <br /> t 12b. <br /> L <br /> - ! . <br /> i <br /> ... <br /> 13a. Total Gross Wages (add Lines 12a only) Total this page only. r <br /> Include this and totals from additional pages in Line 2 on page 1 . l <br /> L 13b. Total Taxable Wages (add Lines 12b only). Total this page only. <br /> Include this and totals from additional pages in Line 4 on page 1 ( , <br /> ._._. —..._ ..... . a <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 identifiers 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 , Florida 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 law. 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 /> Internet Address: www,myflorida.com/dor <br /> - 14 - <br />