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Florida Department of Revenue Employer's Quarterly Report J Re 1 %LICT-6 III IIII III I II III II II IIIiI I II IIII II III II L E t I tx U ,r QUARTER ENDING EMPLOYER'S NAME UT ACCOUNT NUMBER i I I 10 EMPLOYEE SOCIAL SECURITY NUMBER 11 . EMPLOYEES NAME Lolease tr:i bat li eP%e "lrazte-so+ last name a -d first 12a ENIPLOYEE'S GROSS IVAGES PAID THIS QUARTER eg ^a cnar,c;eT, Of fat ^a.^ae o bl.esi I 12b EMPLOYEES AW18LE WAGES PAID THIS QUARTER Cay ro ,1S7,I pad to each ec-.i oar caenpr yea, . +alae. - — U 'r`n. i , ! - 12a. i J .IjP- .r .:� 126. I r , r r 7 i 12a. 7 7 ! 12b. 71 7 ! ' I 12a. I — : t a It, a 1, 12b. 7L _ N r r L J J tea. _ � , I I 12b. 7 ! t II I .tar,, 12b. - . . . . I I r. 1 1, 1.5a1 ' . . l _ r I I II I II I I 7 7 , I;.n a , 12b, . 7 i 1 12a rI I .., ,.: ! 12b. , 7l 13a. Total Gross Wages (add Lines 12a only). Total this page only. Include this and totals from additional pages in Line 2 on page 1 . L 13b. Total Taxable Wages (add Lines 12b only). Total this page only. Include this and totals from additional pages in Lane d on page 1 7 ' DO NOT DETACH Mail Reply To: Social security numbers (SSNs) are used by the Florida Department of Revenue as unique Unemployment Tax identifiers for the administration of Florida's taxes . SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213 .053 and 119.071 , Florida Statutes, and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399- 0180 and federal law. Visit our Internet site at www.rnyflorida .com/dor and select "Privacy Notice" for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions . Tired of paperwork? We can help ! File and pay your Florida unemployment tax online. It 's fast , easy, accurate , and secure . Internet Address www.myflorida.com/dor - 13 -