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CtAkiEr; ENONG <br />10 EMPLOYE -EES SCY•,IAL°ECUNTY M"UhiSER <br />L <br />DO NOT " <br />».. DETACH <br />Mail Reply To -- <br />Reemployment Tax <br />Florida Department of Revenue " <br />5050 W Tennessee St Bldg L <br />Tallahassee FL 32399-0180 <br />Florida Department of Revenue Employer's Quarterly Report RT s <br />R. 01/15 <br />En,;ryerszy'.aliteJtj`,:?aGuar=...j a;Ora,e'eprrsra_�7::rc!ernrZer,e <br />ta�WryorlA' - 6Tdty!axes8&C B, <br />Black Ink <br />, l <br />41. Ev:•?L&EE'S t4AMEVoa rtNiro hG lm*q caxraHer: afk V.. r101i4eand4,"J <br />128 :-AiPL!ME'S UIOSS WAGES PkU IH IIS WARTEF <br />�,:�+.: i•71r. �r� . o f ann min r tausc t - <br />126. Et.?: LOYK'9 TAxAItE W Af I,, Yds TF'•.�c 0"9TER <br />- _ <br />linty trio, rrS Si �1[iui lnw�h uc;a'.ay�a+pa Naldm y&'+: I213rgCtc " <br />12b. <br />■ <br />12a. <br />r <br />i <br />12b. <br />I <br />3 ■ , <br />12x, <br />• <br />12a. <br />i t • <br />12b. <br />� ■ , <br />12a, <br />i ■ <br />12b. <br />f <br />I 1 t .. ■ ! <br />12b. <br />� cM1Ii7. TUt:II Shu pA;)e fN1Iy. <br />13*L. Towl Grons Wage- (aid An" 17, <br />.lucle this and totals tion additiorsd pa+I'in Lina 2 on page 1. <br />• . <br />s 1 <br />�+"roial'IaxaUleWr.,gvs is+1d LItIrm 12b axd'y). loicd 1111 . pama3unly, f <br />- Innlu,la this :and to!Nh hrpn addqu'rcil Imcm!; ra l lire 1 aaa pN;1e 1. i <br />- • . <br />Soda) security nunibels (SSNs) are used by the Rorida Department of Revenue as unique <br />identifiers for the administration of Flonda's taxes. SSNs obtained for tax administration <br />purposes are confidential under sections 2113.053 and 119.01, Florida Statutes, and not <br />subject 10 disclosure as public records. Collection of your SSN Is authorized under state <br />and federal law. Visit our website at %vww.myflorlda.com/dor and select 'Privacy Notice" <br />for more infonnation regarding tie state and federal law governing the collection, use, or <br />release of SSNs; including authorized exceptions. <br />!,!;,ease �,avp your instructions! <br />Quartedy Report innuctions (RT-6N/RTS-3) are only mailed <br />vA th new accounts or when there are changes. If you misplace <br />your instructions, you can download them from <br />www.myflorida.com/dor <br />P127 <br />