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III II IIID I II III II II VIII I II IIII II III Florida Deparbnent of Revenue Emplo en's -Quarterly Report R11�T-6 <br />Errdoy,Ln are re aired to file qdart&ty tax/wage reponspigarolm of errOoyrriR 01Gnt acftjorwhether any taxes are aue. <br />Use Black Ink to Complete This Form <br />WARTER ENDING EMPLOYER'S NAME <br />RT ACCOUNT NUMBER <br />5�2 EMPLOYEE'S GROa WAGES PAIDTH;�OLWRTER <br />0 E�APLOYEFS SOCIAL SECURITY NUMBER 11. EMPLOYEE'S NAME Weas- pan tru tweiie cfiarwerz of Iasi narrL, and Tim I <br />F, 6910 chararlem 0b. -J nam in bores) 12b. EMPLOYEE'S TAXABLE WAGES PAID THE 011AR.TER <br />OnIf the Us I 7(M paid to e%,h employo; pd C2'elft W[CtaxaplF. <br />F IF -1 n F! F -I <br />,"T <br />111-1 110 L1 171— --j F -1 <br />11—d <br />hisi <br />L -j ,_j LJ L ln� 4 1 j 12b. <br />0 <br />F 1] F1 <br />IF <br />L]L _J Li Ll <br />Last <br />P 12a. <br />_J <br />Li <br />F- <br />'4 0 , 12b. J,_ J1 L <br />--10 L <br />Nam 71 J I <br />Fil F1 0 [1 IL 'LIP "e D. 101,110- El LOOK] I] El LIE, 01 <br />L -j Fvsl 112a. f—: <br />Inlpa (—I 12b. J I I <br />F <br />U <br />[]F11 F] -J L <br />L 12... IL <br />_J r -J1 DID 11-1 D! 0 Li <br />F; 7-1 F—I <br />idel� F-1 <br />Mane 12b. <br />L ---J Li <br />11 E. <br />ta- <br />11 1[ 1 D Il 10 1 1: 10 12.. Er <br />- j[]711 11-11-01 U, <br />N2! <br />pe 12b. <br />Fyst 0 El E, 10-11 Cl 11 111111, r I <br />e L 1111iluu. Fill <br />L�� F] F -I i — <br />[jF <br />F <br />L_1F <br />"Ell El U1 [I E Nam L P i E -I L] <br />11 El [] 12, <br />F1 IFT10010FIJ <br />-J L L — Li L-1 <br />FITS] --1 'Iiij" P El 12b. [I El 01. -[IF' <br />Ittitn�D, Eli) <br />Narne 11 D FJ 0, 0 E <br />L] r] F -JI [ —1 � —, 1-3�i � <br />2.. L-1 Ll F <br />r -1011-] 0 011-01[ -F L 110 [01 P, F. E10 - <br />L ED -1-i'L <br />L_J <br />_J <br />0 El [I. Pi E, <br />FuL—IL1111 0110 12b. <br />IJ y El 0011 [El. O -U <br />ul I I "D 01 Eli - 11' -3L I'L 0 FI 0- F <br />JD <br />1—J. i D EJ 2.. L11 <br />ID --'] joj,, T- --I F <br />-j-1 Li i2b. L <br />1 111% IF], LF E I I JI <br />13a. Total Gross Wages (add Lines 12a only). Total this pa& only. r--, <br />Include this U1 <br />and totalts from additional pages in Line 2 on pageI U010 r 11,1101,M <br />L 13b. Total Taxable Wages (add Lihas 12b only). Total this page only <br />Include this and tolats tiprn additional pages -in Line 4 cinpage1 IT -1100 <br />I F 101 01 <br />DO NOT <br />----------------- EYETACH ---------------------------------------------------------------------------------------------------- <br />Mail Reply T(r Social security numbers (SSNs) are used by theflorida Department of Revenue as unique <br />Reemp�lqyment Tax identifiers for the administration offlorida-s.taxes. SSNs obtained for tax administration <br />Florida Departin.ent of Revenue purposes are confidential under sections 213.053 and 119.071" 0orida Statutes, and not <br />50 , 50, W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state <br />Tall6ha§see FL 32399-0190 and federal law. Visit our website at www.myflorida.com/dor and select 'Privacy Notice' <br />for more information regarding the state and federal law.governing the oollection,.use, or <br />release of SSNs, including authorized exceptions. <br />Please save your instructions! <br />Quarterty-Report lnstrqc1ion§(RT-6N1RTS-3)-are only maned <br />with new accounts or when there are cNinges. 11 you misplace <br />your instructions, you can dot unload them from <br />www.myflorida.com/dor <br />107 <br />