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Use black ink. Example A - Handwritten Example B - Typed 11 E `g 1❑❑2 Al 3 ©0®C ❑� 3 �ew�� QUARTERENDING DUE DATE II II NII I II III II I IIN I II NII II Name Mailing Address City/St/ZIP Location Addre ss City/st/ZIP 1. Enter thetotalnumber of full -lime and part-time covered workers who performed services during or received pay for the payroll period including the 121h of the month. 1s11 Month ❑❑❑7❑❑❑ 2nd Month 3rd Month LLJIJa�7��I I Check if final return: [ Date operations ceased. Check if you had out-of-state wages. Attach Employer's Quarterly Report for Out -of -State Taxable Wages (RT-6NF). Exhibit "C" Florida Department of Revenue Employer's Quarterly Report Employers are required to file quarterly tax/wage reports regardless of employment acbmty or whether any taxes are due. RT -6 Use Black Ink to Complete This Form R. 01/15 PENALTY AFTER DATE TAX RATE RTACCOUNTNUMBER, Under penalties of peguty, I decla tr r:r r a r and the facts stated Ind are true (sec�ons 44;,.171(5), Florida Statutes), Title Sign here Siplature of offo;er Date Phone ( ) Fax ( ) Preparor% Preparer check Prepare Paid signature _ if self-employed or PFIN preparers Firm's name (a yours "Date FEIN only if self-employed) ---_..-- --- - -- -. and adcirm ZIP Preparer's phonenumber ( ) TC Rule 7313-10.037 Employer's Quarterly Report Payment Coupon Florida Administrative Code Effecli Date 11/14 Florida Department of Revenue COMPLETE and MAIL with your REPORT/PAYMENT. DOR USE ONLY T Please write your RT ACCOUNT NUMBER on check. 1111 / ❑ ❑ � ❑ ❑ Make check payable to: Fonda U.C. Fund POSTMARK OR HAND-DELIYE RY DATE RT ACCOUNT NO. L__J 11 E F1 L1 F1 LJ F.E.I. NUMBER 1111_1111E1111E11 Name Mailing Address City/St/ZIP L ------------------- FtT-B R. 01/15 L U.S. Dollars Cents Do not make any charges U you do not have an account number, you to the pre-printed are required to rapietarl"s iosfructipnsj It chargese information on this form. F.E.I.NUMBER nn request and complete an c- a Emp/oyerAcoount J Change For -(RTS -3). FOBOIRMUSE01LLyMMM WE Reverse Side Must be Completed 1111/11 [X I 1 a 11 2. Gross wages paid this quarter ❑ �'� �'� (Must toil all pages) ■ ❑ S. Excess wages paid this quarter a'� �'� (See instructions) ❑ . 4. Taxable wages pad this (See instructions) quarter �'� �'� ■ 5. due VulliplyLine 4byTax Rate) ❑��'��'�❑a� �� 6. Penalty due (See (SeeInstructions) ❑�❑'I1011 1111 7. Interest (See instructions) (S ❑ � 1111a �EE■ IL II �❑ 8. Installment fee (See instrucuons) ! ■ ❑ 9a. Total amount due (Se (See instructions) 111111 'il 11119111111 Is[111 96. Amount Enclosed (See instructions) n a �'n n :� ■ If you are filing as a sole proprietor, is this for domestic (household) employment only? Yes n L.] No Under penalties of peguty, I decla tr r:r r a r and the facts stated Ind are true (sec�ons 44;,.171(5), Florida Statutes), Title Sign here Siplature of offo;er Date Phone ( ) Fax ( ) Preparor% Preparer check Prepare Paid signature _ if self-employed or PFIN preparers Firm's name (a yours "Date FEIN only if self-employed) ---_..-- --- - -- -. and adcirm ZIP Preparer's phonenumber ( ) TC Rule 7313-10.037 Employer's Quarterly Report Payment Coupon Florida Administrative Code Effecli Date 11/14 Florida Department of Revenue COMPLETE and MAIL with your REPORT/PAYMENT. DOR USE ONLY T Please write your RT ACCOUNT NUMBER on check. 1111 / ❑ ❑ � ❑ ❑ Make check payable to: Fonda U.C. Fund POSTMARK OR HAND-DELIYE RY DATE RT ACCOUNT NO. L__J 11 E F1 L1 F1 LJ F.E.I. NUMBER 1111_1111E1111E11 Name Mailing Address City/St/ZIP L ------------------- FtT-B R. 01/15 L U.S. Dollars Cents GROSS WAGES (From Line 2 above.) L J ❑��'❑�119E❑E. DE I—I AMOUNT 9blabove.) ❑ [11111 9 E 11 E . 1117 PAYMENT FOR QUARTER ENDING MM/YY I I Check here if you are electing to Check here if you transmitted pay tax due in installments. funds electronically. 9100 0 99999999 0068054031 7 5009999999 0000 4