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III (III III I II III II II VIII I II ( III II III II EnF Florida loyers are (Department ofto file 00atherly lcrW9Revenue Employer's <br /> Quarterly Report` c R oc;s <br /> QUARTER ENDING EMPLOYER S NAME UT ACCOUNT NUMBER <br /> III <br /> .. .. . . . .... ... i __.. _. _. ..... _.. <br /> . 11 . EMPLOYEE'S NAME (please print first twelve characters of last name and first 12a EMPLOYEES GROSS WAGES PAID THIS QUARTER <br /> 10. EMPLOYEE' S SOCIAL SECURITY NUMBER eight characters of first name in boxes) 12b. EMPLOYEES TAXABLE WAGES PAID THIS QUARTER <br /> ....... ............ ...__........ . ....._..... .............; . . ... ...._ __._.. ___ .. _..._ .....__ <br /> Only the Flrst $7000 paid to eam employee per calendar year is taaab'e. <br /> lI` 1 :......................................__..._..................... _ <br /> .......... ............_..___._.__..__...... .......i <br /> 12a. <br /> IN, <br /> Mdcu <br /> i <br /> Fl <br /> JJJ <br /> I � I tvrwI 12a. <br /> ( � ) ( J <br /> I. <br /> _ � ( <br /> M dote <br /> - - - <br /> � ( 12b � I <br /> � � i - 1 [ I IN <br /> J i 12a _--1 �L J <br /> ( � fr <br /> t 12b, <br /> _ I I <br /> N r_ <br /> N t?te ( J �._. L .__._ _._ itil e [_.._.. 12b. - _ ......_ <br /> ILl_ <br /> � , 1 <br /> I i I <br /> IN INN ., ,_ I I <br /> N 3 e Z ':I III IN FI_ ) � I d� . 12b IN - _ <br /> IN <br /> IN <br /> 1 <br /> 13a Total Gross Wages (add Lines 12a onl ) Total this page only. <br /> Include this and totals from additional pages in, Line on page 1 7 � (� FIN <br /> ^�I <br /> 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 . 1 1 IN IN <br /> L <br /> DO NOT <br /> _ AN r _ �. _ <br /> IN _ <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 />