Laserfiche WebLink
Use back ink. Ewample A - HaI [fwtltten EaxTDIE 6 - Typal <br />O❑�❑2 3 4 5 6009❑ ❑ELrn"ICJ❑) <br />04.10RTER Et43115 <br />Name <br />Mailing <br />Address <br />CAyfSt/ZtP <br />Location <br />Address <br />city /St. ziP <br />1. Eder tie Dna rxrn er <br />a'tul-trIe old part-time <br />mewl wives lain <br />petforrned seivfoes didr <br />or received pin for the <br />perraf pe'iad induairlg it* <br />1211 of the rand- <br />Ceck if Tina return:: <br />Date operatic= peened. <br />1z Mo-,t•e <br />22nd Monti <br />aid Month <br />DJE DATE <br />Exhibit "C" <br />Florida Department of Revenue Employer's Quarterly Report <br />Erploms ars raquirec to file quartet tax w e reports retrdoss of errployrrint activity or We -eery tares arc due. <br />3 <br />3 <br />Cne:k if yo: had ou:-ofstate waxen. Attach Employer's <br />Q artedv Report for Out-ofStete Taxabre Wages 17-6N <br />PikilirSign here <br />Paid <br />preparers <br />only <br />Use Black Ink to Complete This Form <br />MALTY AFTER DATE <br />TAX RATE <br />RTA^.,OQUliT NUMBER <br />n <br />RT -6 <br />11.01/13 <br />Da not make any changes Jtyou do not have an amount number, you <br />to the pre-printed are requited to registeseeinst'ucbscs). <br />information en this loom FE! NLtsfBER <br />If changes are needed, - <br />request and cornpfete an — <br />Employer Account <br />Change Form (RT -3). <br />Reverse Side Must be Completed <br />2. G>7ss atagBs paid ha aAartt <br />Oa: tad all pages <br />3. Excess wars paid ho plate - <br />(See rwnicton <br />4. Taxable wages pad this quarter <br />(See irt' uctens <br />S. Tax d.te <br />(Mt 4 y L»e 4 b: Tax Rate; <br />6. Penatp due <br />(See instrtrcton <br />7. ►stere dee <br />(See 'muttons: <br />8. hstalneii fee <br />flee n-'vctms' <br />Ba. t:alame ntd_e <br />(See )nz ucto-rs; <br />9b. Amwnt Endow: <br />(See first-uctirtt5;' <br />Ft l OFfl;atiL1JSEtaJL+ POSTIMI, DATE <br />II <br />3 <br />3 <br />3 <br />3 <br />7 <br />3 <br />7 <br />3 <br />7 <br />7 <br />3 <br />3 <br />3 3 <br />If yon ana filing ea a sole proprie:ce, is ill's for <br />domestic Ihouoehold, emp'pyrne'1t 0,47 <br />Yes <br />VG <br />1J-idatpr. .e..ipexi, oe.aethatr, ereadtt_-eLnar;:t4-fe,Lstat.c 14 axIrce c ar;$4.s,tis)a-w413.:41121.F,ryzStairtes. <br />u.'._1L% <br />Cale <br />Title <br />Ph Dna <br />Fax <br />Prnpute,is <br />drgxreturo <br />Raparnt etseek <br />H eoP-eentikrind <br />Prepier <br />or PIN <br />Fon'e. rwsb fm yotns <br />H ea H-wrybytks.l <br />end adthx ss <br />Rule? D -10.0;r <br />Florida Aominktrariva Code <br />;Orin Daparrn?nt D` Sao3nue <br />RT ACCOUNT NO. <br />F.E.I. NUMBER <br />Name <br />MalIia9 <br />Address <br />CityrSVZIP <br />L <br />1 <br />Witt <br />FEN <br />ZIP <br />tsar <br />plrunt raJr"i'rr. <br />Employer's Quarterly Report Payment Coupon <br />COMPLETE and MAI with your P.EPORTPAYMEN'T. <br />Please write your RT ACCOUNT hJMBER Cr check. <br />Make check payable to: Randa B.C. Fund <br />DETACH <br />DOR USE ONLY <br />I / <br />POSTMARK OR IIAND DELIVERY WE .% <br />II <br />GROSS WAGES <br />{From Liao 2 above.) <br />AMOUNT ENCLOSED <br />(From Line 8o above-) <br />PAYMENT FOR QUARTER <br />ENDING MM/YY <br />Check here if you are electing to <br />pay tax due in instalments_ <br />U.S. Dollars <br />J <br />^17 <br />3 <br />• <br />RT -6 <br />R. 01113 <br />1 L <br />cents <br />Check here if you transmitted <br />funds electronically. <br />9100 0 99999999 0068054031 7 5009999999 0000 4 <br />85 <br />