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UEe back it. Example A - Haravrltt;n Eramo e 6 - Typ d <br />(0 <br />1 <br />OUARiER ENDNO <br />Milne <br />Matting <br />Address <br />City/SVZIP <br />Location <br />Address <br />cry/SVZiP <br />8 <br />9 <br />h. Enter the tWranter <br />o; ttdkine and pan -tare <br />armed natters etc <br />perfarned serukes during <br />arrece5ed pay tar the <br />pe)rull periodr.dig the <br />12th ti the meront. <br />nCheck if final reTurnv <br />Dma operstiona ceaaed. <br />0 <br />n <br />i=_i Month <br />2nd Month <br />3rd Month <br />n <br />DUE DATE <br />Exhibit "C" <br />Florida Department of Revenue Employer's Quarterly Report <br />Employers are required to fde quarterly Whop watts mgrs of etrplv/rrtnt =tidy or theta any taxes are Om <br />. <br />T FIT -6 <br />R. 01/13 <br />i_❑i❑_n <br />Check if you had out -0f atate wages. Attach Employer's <br />Quarterly Report for Out -of -State Taxable Wages- (RI -6144 <br />n <br />Use Black Ink to Complete This Form <br />PENALTY AFTER DATE TAX RATE RT ACCOrJNf NUMBS <br />Do not make any changes <br />to the pre-printed <br />information an this faro. <br />II changes are needed, <br />request and comcptete an <br />Employer Account <br />Change Form (RT -3). <br />Reverse Side Must be Completed <br />2 Gass ams paid Lisraster <br />(l4rttmgallPftP4 <br />3. Excess wafts paid els grarcg <br />(See ifs.-ucim» <br />o. Taxatfewages pard this grirter <br />)See i struisfens) <br />5. Tax due <br />RAZ* Line a by Tax Rate) <br />6. Peery dt12 <br />(See iftancetas) <br />7. Intent the <br />i'cas) <br />a InsWhtadfee <br />(See iratru tuts) <br />9a. ti MtrMI the <br />(See jart <br />9b. toward Bidose <br />(See <br />RT -6 <br />f you do not haw an account poser, jou <br />are requtred to register (see Instructions), <br />EEL NUMBER <br />IMMM <br />COB coma USEOwwyPOSTW1P1DATE <br />im <br />nnn, <br />, <br />❑ <br />❑, <br />,n <br />n <br />—nn,nn❑,-nn <br />❑ <br />--n.n❑n.nn— <br />if you are filing os a sole proprietor, is thi or <br />domestic (household) empkyraent only? <br />Under pens fes of perjury I deflate that 1 have read this felon and the facts mated it it are tris (sayers 443.171( and 443.141(2), Florida Stalrees). <br />ere <br />Title <br />• <br />• <br />n <br />n <br />n <br />❑ Yes No <br />Phono <br />Fteperer ctatk <br />if salr.enployect <br />FEDI <br />Rep. P <br />SSM or PTIN <br />Fax l ) <br />ZIP <br />Poorer b1111 <br />phmr ttzmtm ( <br />J22NOI <br />DETACH <br />Rub 7311-10.037 <br />Roden Ammmsstratirc Coto <br />Florin °ape mam of Revenue <br />T <br />RT ACCOUNT NO. n <br />F.E.I. NUMBER <br />Name <br />Mailing <br />Address <br />city/St/ZIP <br />L <br />411 <br />Employer's Quarterly Report Payment Coupon <br />COMPLETE and MAIL with your DEPORT/PAYMENT. <br />Please write your RT ACCOUNT NUMBER on check <br />Make check payable to: Fonda U.C. Rand <br />nn-nnn❑❑n <br />r <br />DOR USE ONLY <br />❑/ i❑❑ <br />POSTMARK on HAND -DEMENT DATE <br />GROSS WAGES <br />(From Line 2 above.) <br />AMOUNT ENCLOSED <br />(From tile So above-) <br />PAYMENT FOR QUARTER <br />ENDING MM/YY <br />US Doltars <br />n,n <br />n in <br />nn- <br />Check here if you are electing to <br />pay tax due in instafrnents. <br />• <br />RT -6 <br />R. 01/13 <br />L <br />Cents 1 <br />HCheck here if you transmitted <br />funds electronically. <br />9100 0 99999999 0068054031 7 5009999999 0000 4 <br />