Laserfiche WebLink
Use black ink. Example A - Handwritten Example B - Typed <br />`¢ 71A ETPeB <br />0 1 2 3 4 5 6 7 8 9 0123456789 <br />II II III I II III II II I IIII I II IIII II <br />Nart* <br />M ailing <br />Addre ss <br />city/strLlP <br />Location <br />Addre ss <br />City/StlZtp <br />1 Enter the total number <br />of full-time and part-time 1 st Month <br />covered workers who <br />performed services during 2nd Month <br />or received pay for the t <br />payroll period including the <br />12th of the month. 3rd Month 5 <br />Exhibit "C" <br />Florida Department of Revenue Employer's Quarterly Report <br />Employers are required to file quarterly tmiAvage reports regardless of employment activity or whether any taxes are due <br />RT -6 <br />t) $: Black Ink to Complete This Fora: R. 01/15 <br />PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER <br />Do net maloe any changes I you do not haw sp accoun t pumher, you <br />to the pre -prided aro required to regbtor (ase ioabucti1.1Z <br />information on I6• fern' Ff I NUMBER <br />9 chargee are Beaded <br />rattiest and canrobte an _ <br />EmployerAcocunt <br />Change Farm O fS-3). FON OHM USE Only MSMM DME <br />Reverse Side Must be Completed <br />2. Gross wages paid this quarter <br />must total am (rages) <br />3. Excess wages paid this quarter__ - <br />(See instructions) <br />4. Taxable wages paid this quarter <br />(See instructions) <br />5. Tax due <br />(Multiply Line 4 by Tax Rate) <br />6. Penalty due <br />(See instructions) <br />S 5 ■ <br />7. Interest due <br />(See instructions) _ <br />B. Installment fee <br />(See instructions) <br />9a. Totdmood due • <br />(See instructions) <br />Check if final return: / / } } - ■ <br />9b. (Boum ad <br />Date operations ceased. E <br />(See nstructiorlion <br />rs) <br />Check if you had out-of-state wages. Attach Employer's <br />Quartery Report for Out -of -State Taxabk Wages (RT -6th. <br />If you are filing as a sole proprietor, is this for <br />domestic (household) employment only? Yes ; _No No <br />RT ACCOUNT NO. <br />f -—U.& Dollars Cents <br />F.E.I. NUMBER _ GROSS WAGES I i <br />(From Line 2 above.) J!i ;' }j,■ <br />AMOUNT ENCLOSED <br />(From Line 9b above.) ■ <br />7, y <br />Nana 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..+St21P pay tax due in installments. funds electronically. <br />1 <br />Title <br />Sign here <br />Phone <br />( <br />i <br />Date <br />Prapar■r5 <br />Preperer check Reperer's <br />self-employed SSN orPTIN <br />T <br />signature <br />Paid <br />preparers Firm's name (or yours <br />Date <br />FEIN <br />l <br />only if Be" employed) <br />.._._.. <br />_ <br />- <br />and address <br />ZIP pb�oes <br />num <br />DO NOT <br />--------------------------------------------------------'----------------------------------- <br />_ <br />TRO <br />Employer's Quarterly Report Payment Coupon <br />Rr-s <br />le 799-0u03T <br />R. 01/15 <br />Flerlde Admlydstrarve Cade <br />Effective Date 11/14 <br />Florid,Denartir-1cfFr,x,ut <br />COMPLETE and MAIL with your REPORT/PAYMENT.DOR <br />USF ONLY <br />T <br />Please write your RT ACCOUNT NUMBER on check <br />Fbfdda U.C. fund <br />(J f <br />t / <br />L <br />Make check payable to: <br />_ <br />POSTMOR HAD-DEl IVBRY DATF <br />ARKK <br />RT ACCOUNT NO. <br />f -—U.& Dollars Cents <br />F.E.I. NUMBER _ GROSS WAGES I i <br />(From Line 2 above.) J!i ;' }j,■ <br />AMOUNT ENCLOSED <br />(From Line 9b above.) ■ <br />7, y <br />Nana 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..+St21P pay tax due in installments. funds electronically. <br />1 <br />