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III II VIII I II III II II VIII I II IIII II III II L Florida Departmentof Revenue Employer's Quarterly Report R RT-61 Employers are required to 61e quarterly tax./wage rayons regardless of employment activityor whether arty t�css are due. Use Black Ink to Complete This Form QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER i —I -- I LLJLJL i LJ L-1 10. EMPLOYEE'S SOCIAL SECURITY NUMBER lu, I❑" --i- - 71 [11-10-0111-00-1100] L 11. EMPLOYEE'S NAME Weaseprinittw*echmWersofhastnarne and firs l eight grade s of tf91 Warne lo tMxes) dMPLOYEES --�f( --------------------. 12a. EMPLOYEES GROSS WAGES PAID THS QUARTER 12b. E TAXABLE WAGES PAID THIS QUARTER -----------------DETACH----------------------------------------------------------------------- only the rust SrOM paid to each employee per calendar year i�s talz". L -t Nan Social security numbers (SSNs) are used by the Florida Department of Revenue as unique Reemployment Tax �;L i' f _ purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not �11■l.1 subject to disclosure as public records. Collection of your SSN is authorized under state El nst Marne --I0-- for more information regarding the state and federal law governing the collection, use, or ii Atznle Ell €rasa` ,�. release of SSNs, including authorized exceptions. FLast est (( r— --7r Miwia H Pia ie }--` f tu�L— � _ 12a. � I!❑0,00 n !❑t 1� Fit Way. �EI0 i �AtGeie j __;i€ r' I�,—`: irr•7 12b.Last ! ' I �■ Nara —1 -DLJ -E' -�-�-- 12a. j�n j�n t—tLJ,_11.1�,�� ■ First Nal?Itl —i l E dicdle - 1 �- I: f e�h;t ! 1 ,2b. �t- D-, i 17. -- Name --a-- ,�. --- First Nmns —i i;.v!e F7 is �'': u'ij 12b. ^I��1� - -- a111-1. El asi ,are , ,_E ;- -- ,— �--,---,--Fl. '• l L1 F€rst Nal'ie , ii 1 t —`� i 1i le it i I t(y. (j ( l Last 1 Fill D. 0I Fits Fier -� � E di dlP � ,�. I 0, ,I EEIEI 00 1. �--� First '�(—`6—t-) Na. ,- I El■ _ 13a Total Cross Wages (add Lines 12a only). Total this page only. P9 Y Include Uds and totals from additional pages in Line 2 on page 1. l_ � I ' j ' I F7 ■ El 0 13b. Total Taxable Wages (add Lines 12b only). Total this page only. Include this and totals from additional pages in Line 4 on page 1. DO NOT -----------------DETACH----------------------------------------------------------------------- Mail Reply To: Social security numbers (SSNs) are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select "Privacy Notice' for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized exceptions. Please save your instructionsf Quarterly Report instructions (RT-6N/RTS-3) are only mailed with new accounts or when there are change218111 misplace your instructions, you can download them from www.myflorida.com/dor