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Use black ink. Example A - Handwritten Example B - Typed <br />E T pkl A- EXampla-8 <br />0 1 2 3 4 Ft 8: <br />:;0 1 301L i <br />QUARTER ENDING <br />Employer's Quarterly Report Payment Coupon <br />DUE DATE <br />7 -- <br />III II VIII I II III II II illll I II IIII <br />II <br />Name <br />Title <br />Do not inke any changes Ifyou do not have an account number, you <br />Mailing <br />inforinafion on this lonn. FE.LNUMBER <br />It changes we needed, <br />Florida Department of Revenue <br />request and complete an <br />EmpkywAccount <br />Addre ss <br />Phone <br />--[Fa <br />Change F— (HTS -3). FOB MMUSE OWPOS MADATE <br />Citylstmp <br />Reverse Side Must be Completed <br />2. Grosswagespaid this quar1ler <br />(Must 101:31 all pagest <br />Location <br />3. Excess wages paid this quarter <br />(See instructors) 1111 -E•iE] <br />El <br />Addre ss <br />4 Taxable wages paid this matter <br />(Seeinstruallons) E `1 <br />Preparer check <br />5. Tax due <br />(101ultply Line 4 by Tax Rate) <br />Citylsvzlp <br />6 Penaltyclue -7 <br />(See insti <br />Paid <br />--J T <br />I Enter the li-ital number <br />of full-time and part dame 1st Month <br />7 interest due <br />(See instructions) <br />I DE110 <br />coveredwPrkem wt.0 <br />GROSS WAGES—y <br />(From Line 2 above) <br />8 Installment fee <br />penormied services during <br />or received pay for the 2nd Month <br />9b. Amount Eldillsed F, <br />(Seeinstructons) L jT: <br />F7 [I <br />payroll penod inclunng the <br />1,211h ofthemorith- 3rd Month <br />AMOUNT ENCLOSED <br />. 717 <br />1� <br />.Date <br />Check if final retum: <br />Date operations ceased. <br />Check if you had out- A -state wages. Attach Enr9byer%; <br />Quarterty Report for Out -of -State Taxable Wages (R T-6 N Q. <br />Exhibit "C" <br />Florida Department of Revenue Employer's Quarterly Report <br />Employer's Quarterly Report Payment Coupon <br />Employers ployers are required to fl e quarterly tmAage reports regardless of employment activity or whe dtw any tax as are due. <br />RT -6 <br />Use Black Ink to Complete This Form R. 01/15 <br />T <br />PENALTY AFTER DATE TAX PRE RTAXOUNTNUMBER <br />R. 01/15 <br />Title <br />Do not inke any changes Ifyou do not have an account number, you <br />to the pre-prialled are required to register {see instruotions)t <br />inforinafion on this lonn. FE.LNUMBER <br />It changes we needed, <br />Florida Department of Revenue <br />request and complete an <br />EmpkywAccount <br />)R USE ONLY <br />Phone <br />--[Fa <br />Change F— (HTS -3). FOB MMUSE OWPOS MADATE <br />L � / —�' <br />Reverse Side Must be Completed <br />2. Grosswagespaid this quar1ler <br />(Must 101:31 all pagest <br />�� <br />LPOSTMARK OR NAND -DELIVERY DATE <br />3. Excess wages paid this quarter <br />(See instructors) 1111 -E•iE] <br />El <br />preparer'a <br />4 Taxable wages paid this matter <br />(Seeinstruallons) E `1 <br />Preparer check <br />5. Tax due <br />(101ultply Line 4 by Tax Rate) <br />6 Penaltyclue -7 <br />(See insti <br />Paid <br />--J T <br />1 <br />7 interest due <br />(See instructions) <br />--N or PTIN <br />kms, <br />E :1 EE <br />GROSS WAGES—y <br />(From Line 2 above) <br />8 Installment fee <br />(Seeinstruclions) <br />9a. Total annual due <br />(See instruclions) <br />9b. Amount Eldillsed F, <br />(Seeinstructons) L jT: <br />F7 [I <br />lifyou are filing as a soleproprietor, is this for <br />AMOUNT ENCLOSED <br />domestic (household) employment only? V <br />if8eir-amployed] <br />Rule 73111-10.037 <br />Employer's Quarterly Report Payment Coupon <br />RT -6 <br />Florkle Adminialtrallive Go" <br />ISign <br />R. 01/15 <br />Title <br />here <br />Florida Department of Revenue <br />COMPLETE and MAIL with your REPORTMAYMENT. <br />)R USE ONLY <br />Phone <br />--[Fa <br />Please write your RT ACCOUNT NUMBER on check, <br />Make check payable to: Rmich tI.C. Fad <br />L � / —�' <br />L <br />Date <br />�� <br />LPOSTMARK OR NAND -DELIVERY DATE <br />preparer'a <br />Preparer check <br />-------- <br />Prepo'e..'s <br />Paid <br />1 <br />if sel"implafed <br />--N or PTIN <br />kms, <br />E :1 EE <br />GROSS WAGES—y <br />(From Line 2 above) <br />— ----- ----- -- <br />preparers <br />Firm's name for yrs <br />FEIN <br />AMOUNT ENCLOSED <br />only <br />if8eir-amployed] <br />.Date <br />(From Line 9b above.) <br />end address <br />ZIP <br />Preparers <br />Mailing <br />phone number <br />Rule 73111-10.037 <br />Employer's Quarterly Report Payment Coupon <br />RT -6 <br />Florkle Adminialtrallive Go" <br />R. 01/15 <br />Efteofte Date 11/14 <br />Florida Department of Revenue <br />COMPLETE and MAIL with your REPORTMAYMENT. <br />)R USE ONLY <br />7 <br />Please write your RT ACCOUNT NUMBER on check, <br />Make check payable to: Rmich tI.C. Fad <br />L � / —�' <br />L <br />�� <br />LPOSTMARK OR NAND -DELIVERY DATE <br />RT ACCOUNT NO. <br />11 LJ <br />1 <br />Cents I <br />F.E.I. NUMBER <br />El - <br />kms, <br />E :1 EE <br />GROSS WAGES—y <br />(From Line 2 above) <br />-1 <br />AMOUNT ENCLOSED <br />(From Line 9b above.) <br />Name <br />PAYMENT FOR QUARTER <br />Mailing <br />ENDING MM/YY IF, <br />Address <br />Check here if you are electing to Check here if you transmitted <br />cjtyfstjzlp <br />pay tax due in installments- funds electronically. <br />L9100 <br />0 99999999 0068054031 7 5009999999 0M <br />4 <br />