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Use black ink. Example A - Handwritten Example B - Typed Example A Example B 0 1 2 3 4 5 6 7 8 9 -,1113456789 QUARTER ENDING DUE DATE III II VIII I II III II II VIII I II IIII II Name F Mailing i Address City/St/ZIP Location Address City/st/ZIP 1. Enter the total number of full-time and part-time covered workers who performed services during or received pay for the payroll period including the 12th of the month. 1st With I[I L 7 F1 2nd Month I I l, ! , �J lh__I iL—'' I 3rd Month 1 1, 1 1E Check if final return: Date operations ceased. Check if you had out-of-state wages. Attach Employer's Quarterly Report for Out -of -State Taxable Wages (RT-6NF). Exhibit "C" Florida Department of Revenue Employer's Quarterly Report Employers are required to file quarterly taxAuage reports regardless of employment acnity or whether any taxes are due. RT -6 Use Black Ink to Complete This Form R. 01/15 PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER I Do not make any changes B you do not terve an account number, you to the pre-printed are required to register (see instructions} 7`''.— is J., y nnfmmaliI on this form' F.E I NUMBER If charges are needed, ---F, —F request and complete an _ 7SignherePhone EmpfoyerAccount _ _I Change F-- (RTS -3). FOR OFFICIAL USE ONLY POSTMAW( DATE n Reverse Side Must be Completed COMPLETE and MAIL with your REPORT/PAYMENT. Please write your RT ACCOUNT NUMBER on check. dda I.I.C. Make check payable to: Fb.C. Fund DOR USE ONLY —, / 1111 � / 11— �' J POSTMARK OR HAND -DELIVERY DATE 2. Gross wages paid this quarter (Must total Al pages) [l]■. [❑1 E i �''� '�❑I 3. ExcessaLSee instructions) L_ 4. Taxable wages paid this quarternr (See instructions) J E E01. f l LLJJ 5. Tax due Multiply Line 4 by Tax Rate) �� _'� � � . 0 E 6. Penalty due (See instructions) a �'n ■ a ILJi 7. Interest due (See instruct ons) - I IF I1 __ n f J U —]. 11 C 6. Installment fee (See instructions) ' 9a. Total amount due (See instructions) ! Prepazer's ( — Preparer's n ■ I_ 9b. AmouttEndesed11 (See instructions) �, -_ — I � �j J F L__I i '— j' n I ■ J E 1 1L—f If you are filing as a sale proprietor, is this for domestic (household) employment only? Yds L] fJc ----------------------------------------------------------------------------------------------- r'.J �, J:'"lIt r.. - 11 ) - -i 7`''.— is J., y :: 7SignherePhone RT -6 R. 01/15 Title of Revenue T COMPLETE and MAIL with your REPORT/PAYMENT. Please write your RT ACCOUNT NUMBER on check. dda I.I.C. Make check payable to: Fb.C. Fund DOR USE ONLY —, / 1111 � / 11— �' J POSTMARK OR HAND -DELIVERY DATE Fax 3�giaaireororrice� Date t ( ) ! Prepazer's Preparer check Preparer's ^ Paid signature - - if self-employed j — SSN or FrIN preparers Firm's nems (or yours Date FEIN lf-employed) —__d LL__�e address ZIP Reparer's phone number ( ) DO NOT ----------------------------------------------------------------------------------------------- DETAOR Ru1a738-10.017 Florida Administrative Coda Employer's Quarterly Report Payment Coupon RT -6 R. 01/15 Effeothra Data 11/14 Florida Department of Revenue T COMPLETE and MAIL with your REPORT/PAYMENT. Please write your RT ACCOUNT NUMBER on check. dda I.I.C. Make check payable to: Fb.C. Fund DOR USE ONLY —, / 1111 � / 11— �' J POSTMARK OR HAND -DELIVERY DATE RT ACCOUNT NO. Ll CI 0 L • GROSSWADoCan ara Ce its (From above. NUMBER 1111n E El �1 [�1 11�1'_�1L■ '11 _ AMOUNT EN11❑11j][EgEan■ I�1 rw, (From Line 9b above.)bove.) L Name PAYMENT FOR QUARTER Mailing ENDINGMM/YY u� Address Check here if you are electing toCheck here if you transmitted City/SiUZIP pay tax due in installments. 1-1 funds electronically. L 9100 0 99999999 0068054031 7 5009999999 0000 4