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DRAFT <br />III <br />II <br />IIID <br />I II <br />III �) <br />II IIIII <br />I II IIII <br />II <br />III') <br />Florida Department of Revenue Employer's Quarterly Report RT -6 <br />Employers are required to fila uartarly taxhvage reports regardless of employment ent activity or whether any taxes are due. R. 01/15 <br />Use Black Ink to Complete <br />This Form <br />QUARTER ENDING EMPLOYER'S NAME <br />El 11 CI F1 0 G 1, <br />RT ACCOUNT NUMBER <br />1111001 !n11 <br />10. <br />-_—n—[0'01001 <br />EMPLOYEES SOCIALSECURITYNUMBER } <br />_ — <br />11.EMPLOYEE'SNAME (pleaseprirtfir^sttwdwcreracrersoflast nameandfis <br />eight,.a terz of first name in boxes) <br />7237 EMPLOYEE'S GROSS WAGES PAID THIS OUARTER <br />72b. EMPLOYEE'S TAXABLE WAGES PND THIS OUARTER j <br />only the $7,000 pai�dto each em{ployeo per calendar year is laz�jab!e.I I <br />�, <br />Pl1❑!00 [ i 1001 <br />Name �❑t-1P00PF11 <br />i�l� <br />12a. <br />�first <br />�� i __jt 1I <br />��l���■! <br />Imo' <br />First <br />Name <br />❑ <br />t— <br />�jj�j <br />l—_ t_�i <br />Mtddle <br />(�ru�tial <br />❑ <br />12b. <br />_ <br />i(}L�J�� <br />■ J <br />(�(� j.. � (((j �jt <br />E__11 j L.I a t! ❑ J- 1 �I <br />fr❑�� <br />Arne �j <br />❑ <br />�(❑� <br />1_1 <br />�� {} <br />!�1 �� L— IJ L_ <br />a <br />1237 <br />j� �� (� �� <br />l ALJ —! <br />�1 _ <br />jj� <br />_ ■ <br />i <br />F <br />Nae J <br />n�j <br />F_j <br />[ -11101111 <br />��� <br />Nlidd•.a <br />Ing a� <br />o <br />12b.. <br />11 <br />�} j <br />i �I_I <br />u <br />. 1011 <br />�j j f <br />t_10❑_1�€ i�J <br />j{ <br />Name J❑O_I❑t�L_!�_ <br />J � 1237 <br />� j <br />���iLJ_1,■10 <br />C <br />First. !�j <br />Name <br />101(_ <br />��j <br />�� <br />i <br />�rv� <br />j��}� <br />0.0 <br />—I <br />M�adle 01 <br />I xh2 12b. <br />� ■ <br />1� <br />F1 F11 1 [1 � — �� _ <br />j�El j <br />Nam L_7 l _1 <br />j��1�_1! <br />I� <br />IJ L� <br />�01 <br />Li 123. <br />j��{�_'� <br />lJ o �L _l <br />ji � <br />�— 1 1 <br />j(L�! <br />El . i_1 <br />�7j <br />j <br />_J <br />First <br />Name L����❑l <br />I❑� <br />lrtitial LJ 12b. <br />( i ( <br />(I�' t <br />t ill'■ <br />}.� <br />��' r` <br />I� E .I <br />Lzst �! �{�?j <br />Nam Li <br />jai' IIt <br />lJ 1� �! <br />3,� <br />❑'�—! <br />�I {!� <br />! —i <br />, <br />� i 1_I LJ 123. <br />t_ <br />—i <br />1 � <br />'� <br />•.�i <br />F, t �,((( <br />Name J <br />U <br />, �( �j til <br />J L <br />—� jj�� <br />L— L—! <br />11���jjj, <br />L�t <br />Mldd!e <br />tra; z! �j 12b. <br />I <br />� %t <br />1 �(�jj <br />_1 ■ �l <br />s <br />_ ' I � � �'Y <br />I L__.! 0 — 01 ` t1 E i_.J i�i <br />Last ' i <br />tram- � <br />❑ <br />(�j (� <br />I i ! <br />❑ <br />0 L..._! <br />1111 <br />�! <br />11 <br />� "! i—t <br />i � 11'i—II 1237 <br />� . I � � j� <br />11FID LJ <br />i 1 <br />1 <br />_ <br />� L_ � ■ . <br />fist �-� <br />Name L� <br />1I�( <br />(— <br />r�!�jjl <br />i <br />M bile. <br />nfi� 12b. <br />ILS' 5 —1 <br />�� <br />I I� <br />r <br />j ' <br />. F <br />�i <br />L_ J <br />j <br />C 1 �___ i� 11 } <br />Name <br />❑ <br />r <br />` 1 '[][]E" <br />l ] <br />n� <br />J <br />t_ ❑ ! , 12a. <br />111111701 i— <br />i—i <br />�E11,17111, <br />I E + 1 ■ E_! <br />LJ <br />—1 <br />First <br />Nave n <br />_U <br />j <br />0 <br />i" MrdSRe <br />n y Irath� 12b. <br />1 <br />� <br />I <br />k <br />FF] El F1 -� - � <br />m- �u <br />a <br />�� fl -] 123. <br />F][11EEl0,[00.❑LI <br />first I—' <br />Name li i_111 <br />�T <br />[ 1 I <br />�� Mrddie t <br />( F :_f 0 "' J 12b. <br />( <br />t <br />!� <br />(, '! f� <br />gL� � L� . I� <br />1337 Total Gross Wages (add Lines 12a only). Total this page only. <br />Include this and totals frau additional pages in Line 2 on page 1.LJ <br />i <br />I <br />i '� <br />Ir -11 <br />1 n <br />9000.00 <br />L <br />13b. Total Taxable Wages (add Lines 12b only). Total this pageonly. <br />Include this and totals from additional a es in Line 4 on page 1. <br />, j <br />DO NOT <br />----------------- DET/CCN------------ <br />`_--------------------------------------------------------------_-"_--____ <br />Mail Reply To: <br />Reemployment Tax <br />Social security numbers (SSNs) are used by the Florida Department of Revenue as unique <br />identifiers for the administration of Florida's taxes. SSNs obtained for tax administration <br />Florida Department of Revenue <br />5050 W Tennessee St Bldg L <br />purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not <br />subject to disclosure as public records. Collection of your SSN is authorized under state <br />Tallahassee FL 32399-0180 <br />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 collection, use, or <br />release of SSNs, including authorized exceptions. <br />Please save your instructions! <br />Quarterly Report instructions (RT-6N/RTS-3) are only mailed <br />with new accounts or when there are changes. If you misplace <br />your instructions, you can download theUJa f[om <br />www.myflorida.com/dor <br />