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III II VIII I II III II II VIII I II IIII II III II Florida <br />oDepartment a Revenue Qu�or rtwthprt Ill <br />L Employers quarterly regardless Imewhether any taxes due. JR. 0/15 <br />Black Ink fete This Form <br />QUARTER ENDING EMPLOYER'S NAME <br />10. EMPLOYEE'S SOCIAL SECURITY NUMBER <br />0 <br />RT ACCOUNT NUMBER <br />11. EMPLOYEE'S NAME (pease i first twelve characters of lest name and first 12a EMPLOYEE'S GROSS WAGES PAID THIS QUARTER <br />eight characters of first name in boxes) 12b EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER <br />Onry1hetir9ST.000paidto Bad employee per calendar year istaxable. f <br />1211 ❑ �__ l,�_I ❑ Ll. ❑ ❑ <br />12.. ❑❑❑,❑❑❑,❑❑❑. ❑❑ <br />12b. ❑,❑❑❑■ F1 <br />12.. ❑❑,❑❑,❑❑re ❑❑ <br />2b. re <br />12a [_ 1 ❑ 11,C_ C_� ❑ . ❑ [.__ l <br />121). ❑❑,❑❑❑re 11 —1 <br />12.. ❑❑❑i❑❑❑,❑❑FILE <br />12b. ❑ ,[❑ ❑ ❑ ■❑ ❑ <br />12.. ❑❑❑,❑❑o,a❑❑. ❑Ll <br />,21). ❑[_ re <br />12a. ❑ � <br />12a. J❑❑,❑❑❑,❑❑Fl. ❑n❑ <br />12b. ❑�,1J[I. ❑`-J <br />I u Li re 11 <br />121). (❑ LJ,❑ ❑ re ❑ <br />13a. Total Gross Wages (add Lines 12a nalypages i this page p lyg ❑ ❑ ❑'❑ 1 L !❑ ❑ 1111 <br />In, <br />this and totals from additional es in Line 2 on a e 1. Ell <br />� r-� I <br />13b. Total Taxable Wages (add Lines 12b only). Total this page only. ❑ <br />Include this and totals from additional pages in Line 4 on page 1. f , j I F re __ <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 />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 />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 />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 />Tease save your instructions! <br />Quarterly Report instructions (FT-6N/FTS-3) are only mailed <br />with new accounts or when there are changes. If you misplace <br />your instructions, you can download them from <br />www.mytiorida.com/dor <br />