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III II VIII I II III II II VIII I II(III II III II L Tpic erFlorida Department Revenue Employer's Quarterly Report Rs are requited to the uarterl• tax/w/wage rear's re_,ardless or cr whether any taxes aredue. R,p1/i/15 5 <br /> Black Ink`, t_ . ;_ih13 F(%;,,;: <br /> QUARTER ENDING U FLOYER'£"IAME nT AC �UM1I r Ull lf•,18ER <br /> 1G EPdr'LOYEPSa ( IN"E URITI'NUNIBER i 11 EMPLoYEE'ShAMEgifa39p1111f51Weh:9CI93ler5o(Ia::+naneandW-11 lzn EMPLOYEE'S GROSS'yAGESPAUTH180UA.VEP, <br /> eiPT chaiacee¢.,i mi riaroe lr boxes) 1Cb FMPL,�YEPS WXAE1L'NAGLS FAIL,THiS OUARTEF <br /> Oiry the first.V fG pain to each amp oy.,per wImder year�c iv bl9 <br /> 12a. • <br /> 12b. • <br /> 12b. <br /> 12a. J • <br /> 12b. • <br /> 12a, t y, • <br /> 12b. • _ <br /> 12b, ■ <br /> 1 <br /> _ 12a, <br /> 12b. e <br /> 12a. a <br /> 12b. • <br /> _ 12a, a - - �` '- -- ■ - <br /> 12b, • _ <br /> 13a Total i;rnss Wages(add Lines 12a only). Total this page only. <br /> i Irn,lude this and totals trorn additional pages in Line 2 on page I <br /> <13b Intal l"axatJe,Wages'add Lines 12b only). Total this page only <br /> L 1 11.... ........... <br /> Include this and totals trom additiunal pages in Line 4 on page..1. <br /> DO NOT <br /> Mail Reply Tor Social security numbers(SSNs)are used by the Florida Department of Revenue as unique <br /> Reemployment 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;anc 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 32399-0150 and federal laver. Visit our website at www.myflorida.com/dor and select"Privacy Notice` <br /> for more information regarding the state and federal law governing the collection,use,or <br /> release of SSNs,including authorized exceptions. <br /> Quarterly Report instructions(RT--6N/RTS-3)are only mailed <br /> with neva accounts or when there are changes.If you misplace <br /> your instructions,you can download them from <br /> wvAa.m yflori da.com/dor <br />