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2022-244
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2022-244
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Last modified
12/20/2022 10:57:13 AM
Creation date
12/20/2022 10:54:44 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
11/22/2022
Control Number
2022-244
Agenda Item Number
12.A.1.
Entity Name
Kessel Medical, Inc.
Subject
. Job Grant Agreement for Local Job Grants
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Exhibit "C" <br />Sign here <br />Phone <br />Date i ) <br />Preparers Preparer check Properer's <br />Paid signature rt self-employed SSN or PTIN <br />preparers Firm's name (or yours Date FEIN <br />I f I <br />f only i se. -amp oyed) <br />and access <br />Florida Department of Revenue Employer's Quarterly Report <br />Use black ink. Example A - Handwritten Example B - Typed <br />Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due, <br />Example A Example B <br />01 234 56789 0123456789 <br />L <br />RT -6 <br />phone number r <br />Us- Black Ink to Complete This Form <br />R. 01/15 <br />WARTERENDING DUE DATE <br />PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER <br />DO NOT <br />--------------------------------- <br />--------------------------------------- <br />... <br />--------" ----------- <br />1)�TACR <br />Employer's Quarterly Report Payment Coupon <br />Do not make any changes you do notan account number, you <br />Rule 738-10.037 <br />I I I <br />II III <br />I I <br />I I <br />I I II <br />II <br />I II <br />I I <br />I I I <br />I I I I <br />II <br />a to re <br />to the pre -prided are required to register (see instructbns} <br />to <br />II <br />Please write your RT ACCOUNT NUMBER on check. <br />T <br />L <br />Make check payable to: Fbride U.C. Fund <br />POSTM ARh OR HAND -DELIVERY <br />information on this form. F.E I NUMBER <br />If changes are needed, <br />request and complete an _ <br />EmployerAaoount <br />Change Form (RTS -3). FOR OFFICIAL USE ONLY POSTMARK DATE <br />Reverse Side Must be Completed <br />Narne <br />2. Gross wages paid this quarter <br />Mailing <br />(Must total all pages) <br />Address <br />city/svzlp <br />3. Excess wages paid this quarter <br />(See instructions) <br />4. Taxable wages pand this quarter <br />(See instructions) <br />Location <br />■ <br />Address <br />5. Tax due <br />(Multiply Line 4 by Tax Rate) <br />City/stop <br />■ <br />6. Penalty due <br />1. Enter the total number <br />(See instructions) <br />of full-time and part-time 1st Month■ <br />9 <br />7. Interest due <br />covered workers who <br />(See instructions) <br />performed services during <br />2nd Month <br />,l „r ■ <br />or received pay for the 3 <br />6. Installment fee <br />payroll period including the <br />(See instructions) ■ <br />12th of the month. 3rd Month <br />9a Total amount due <br />(See instructions) I__'' ■ <br />Check if final malum:Amot <br />Date operations ceased. <br />i <br />9b. nt Enclosed <br />(See in <br />(See nstructions) i <br />■ <br />Check 0 you had out-of-state wages. Attach Employer's <br />If you are filing as a sole proprietor, is this for <br />Quarterly Report for Out -of -State Taxable Wages (RT-6NIF).rry- <br />�-- <br />domestic (household) employment orgy? <br />_..INo <br />Cagier ci c rl � " 1 oFr lac trtat `: ha e read this <br />return Ti the fK:ts stated in it are pue (sect cl ,d_ <br />Sign here <br />Phone <br />Date i ) <br />Preparers Preparer check Properer's <br />Paid signature rt self-employed SSN or PTIN <br />preparers Firm's name (or yours Date FEIN <br />I f I <br />f only i se. -amp oyed) <br />and access <br />erer's ` <br />ZIP Prophone <br />L <br />phone number r <br />DO NOT <br />--------------------------------- <br />--------------------------------------- <br />... <br />--------" ----------- <br />1)�TACR <br />Employer's Quarterly Report Payment Coupon <br />RT -6 <br />Rule 738-10.037 <br />R. 01/15 <br />Florida Administrative Code <br />Effective Data 11/14 <br />Honda Departmerit of Revere.:, <br />COMPLETE and MAIL with your REPORT/PAYMENT. <br />USE <br />T <br />Please write your RT ACCOUNT NUMBER on check. <br />T <br />L <br />Make check payable to: Fbride U.C. Fund <br />POSTM ARh OR HAND -DELIVERY <br />DATE J <br />RT ACCOUNT NO. <br />U.S. Dollars Cents <br />F.E.I. NUMBER _ GROSS WAGES <br />(From Line 2 above.) ■ <br />AMOUNT ENCLOSED <br />(From Line 9b above.) , ■ <br />Name PAYMENT FOR QUARTER <br />ENDING MM/YY <br />M ailing <br />Address Check here if you are electing to Check here if you transmitted <br />City/St/ZIP pay tax due in installments. funds electronically. <br />L 7 5009999999 0000 4 <br />9100 0 99999999 0068054031 <br />
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