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CLB Backup 09/21/2016 CLB MEETING BACKUP DOCUMENTS SEPTEMBER 21 , 2016 CO tiler County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA September 21, 2016 9:00 A.M. COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING BOARD OF COUNTY COMMISSIONERS CHAMBERS ANY PERSON WHO DECIDES TO APPEAL A DECISION OF THIS BOARD WILL NEED A RECORD OF THE PROCEEDINGS PERTAINING THERETO, AND THEREFORE MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS IS MADE, WHICH RECORD INCLUDES THAT TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED. I. ROLL CALL: II. ADDITIONS OR DELETIONS: III. APPROVAL OF AGENDA: IV. APPROVAL OF MINUTES: A. August 20, 2016 V. PUBLIC COMMENTS: A. VI. DISCUSSION: A. VII. REPORTS: A. VIII. NEW BUSINESS: A. Orders Of The Board B. David Linscott-Schoolhouse Plumbing, Inc.-Review of Credit C. Michael Paul Duke- Performance Turf LLC-Second Entity D. Juan C Docampo- Patron Home Services- Review of Credit E. Wallace Booth- Paradise Electrical Concepts&Solutions, Inc.- Review of Credit F. Ben Mading-Adria Group- Reinstatement IX. OLD BUSINESS: A. Natalina Capone- PMT of Naples, Inc.-Second Entity X. PUBLIC HEARINGS: A. 2016-04—Jimmy M. Dean- D/B/A J. D. Design Construction, Inc. XI. NEXT MEETING DATE: WEDNESDAY, OCTOBER 19, 2016 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 VIII ! 111111111111111111111111111111111111111 Florida Department of Employer''s Quarterly Reporte RT-68436 R. 01/15 856202014123100680540312500292820900005 COMPLETE and MAIL your REPORT/PAYMENT to 5050 W.Tennessee St.,Tallahassee,Florida 32399-0180 Employers are required to file quarterly tax/wage reports regardless of emplo ment activity or whether any taxes are due. Quarter Ending Due Date Penalty After Date Tax Rate RT Account Number 12/31/2014 01/02/2015 02/02/2015 .0540 2928209 Employer's Name WALLACE BOOTH ELECTRIC F.E.I.Number 27-1133248 Mailing Address 1835 DOGWOOD CT. For Official Use Only- Postmark Date City/State/ZIP MARCO ISLAND FL 34145 1 Enter the total number of full-time and part-time covered workers who performed services during 1st Month 4 or received pay for the payroll period including the 12th of the month 2nd Month 4 3rd Month I 4 2 Gross wages paid this quarter(Must total all pages) 40,722.00 3 Excess wages paid this quarter(See instructions) 40, 722.00 4 Taxable wages for this quarter(See instructions) 0.00 5 Tax Due(Multiply Line 4 by tax rate) 0.00 6 Penalty Due(See instructions) 'moi,OAy 7 Interest Due(See instructions) 8 Installment Fee(See instructions) 9 a Total Amount Due(See instructions) 0.00 9 b Amount Enclosed(See instructions) 3 0 0.00 If you are filing as sole proprietor,is this for domestic household employment only? LI Yes ❑No —Check if you had out-of-state wages.Attach Employer'sCheck if final return —Quarterly Report for Out-of-State Wages(RT-6NF). ❑Date operations ceased. Under penalties of perjury,I declare that I have read this return and the facts stated in it are true(sections 443.171(5),Florida Statutes). (DO NOT DETACH) FLWA0101 02/06/15 FW2 Signature - Date Signature of Preparer Title Telephone Number Preparer's Telephone Number FLWA0101 02/06/15 FW2 8436 WALLACE BOOTH ELECTRIC El Check here if you transmitted DOR USE ONLY RT-6 funds electronically R. 01/15 1835 DOGWOOD CT. RT Account Number: 2928209 MARCO ISLAND FL 34145 POSTMARK OR HAND DELIVERY DATE Rule 73B•10.025 LL.t Florida Administrative Code 2928 271133248 4 4 4 L9--f-"t 4072200 4072200 0 0 r,0' ' ._,.. 0 0 0 0 . ,=v __ 0 0 0 0 t../.2 `� 0 0 0 0 .. Li 0 0 0 - 0 .s! 0 0 0 0 c 0 0 0 0 8562 0 20141231 0068054031 2 5002928209 0000 5 • Florida Department of Revenue Employer's Quarterly Report Use black ink. Example A-Handwritten Example B-Typed Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. ,,". Example A Example Er 2",, 1 rall[211341511761-111111$41 IT 11011V 4%17BI911 I i RT-6 Use Black Ink to Complete This Form R.01/15 QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER 3 / 3l1 1/ 2 0 al I ! / Fir7 , , - 1 [--- ' " 1 q . 04/01/2016 1 1 04/30/2016 I 1 .0540 1 121191121[811 211011 91 - III IIIIIII I ll III 11 li 1011111111111 Do not make any changes If you do not have an account number,you to the pre-printed areNUre:BuElfired to register(see instructions). information on this form. F.E.I..If changes are needed, . ,. I : , „ request and complete an , 1,, -7 --i 1, 1,, 3i 3 2141i 8 Employer Account ! i ' i ! ')1.. i i 11.. ...1i ;I I I.. Change Form(RTS-3). Fop(*Ram usE asypognmRk DATE , •., : , .; , 3 , . ,,; • WALLACE BOOTH ELECTRIC ' " "' s 1 u 1 everse Side Must be Corripieted , • •/- •- • I 1 '1 1 1 11 Name 1835 DOGWOOD CT 2 Gcssvws peidthisquxter I 11 1 i 1 F.-.... r 11 i 1 IF 1 1 i II- 1 rviailing Address MARCO ISLAND, FL 34145 pusttdal all pages) ; :; ;I , ; ! ,i ! ; ;; ; :• : 0:; 0: 3. Excess wages paid this quarter CityiSL'ZIP ,"i li ! i ! I! I (See instructions) IIIIIII iiiiiIIIOHOI ,..._.:• •, , ll/, ,..........i;.. .._1 yi... • 1........_J• A Taxable wages paid this quarter (See instructions) I : II 11 I i il I 1 1 011 0: Lariation Address 5. Tax due ,• ., ,. .. . . fin ; .. , • ; , (Multiply Line 4 by Tax Ratej : i; ;I .: City/St/ZIP 3L...._ , I L „I 7L :: : :• ; -......._, 6. Penalty due . - ,. • . . .. . . t f ..' ; :: . N 1. Enter the total number (See instructions) : !! : ! ' !: ! f,, I: , (-/0 , ;; ....;7;. ,, -.1 .• , M full-time and part-time 1st Month , I: :i I I :1 1 i 0 I covered workers who ...I i It .17t. 11 11 1 7. Interest due I ,1 i E ; : :, 7 ;---lf---7,-- ! !! I 1 ! ! !! : ! !! ! i : !I {See instructions) . ., . performed services during 2nd Month 1 I I I 1 I I i 1 ;; I or received pay tr the I il il fyi. II 1101 8. Installment fee payroll period including the17111i i 11-11-17- (See instructions) 12th of the month. 3rd Month 1 I I I i I 1 1 ;: L J I I: .111. A. it , 9a Total amount due (See instructions) 1 II II ; I 1 il i i il 1 : I DI 0 r--1 Check it final return: I 11 1 /1 1 lir Is is 1 1 9b. Amount Enclosed f H ••li 1 i i ii ., .1 I if _fel- „:4 ..., 1,......j Date operations ceased. ; ;; ;/ ; i i / ; i i i i j i (See instructions) i li d i l ;I 1 ii ilyrj I iL:',U ..J,L. i i a. ,• , ,I r I Check if you had out-of-state wages.Attach Employer's If you are filing as a sole proprietor,is this i for r 1 1 Quarterly Report for Out-of-State Taxable Wages(RT-6NF). domestic(household)employment only? i_i Yes 1_,J No 4.;:'4,4••••••,v••wool:4r'v:: 1 Sign here 4 )fi:............ce, Date I !Title I Phone , , Fax)., 1 : : • :al : ! , :al Preparers .01, V.t."4 ec)citt4ZAIA.-- Preparer check ni l PreParees • • 1 I signature if self-employed i i I SSN or PTIN i Paid 1 preparers 1 Firm's name(or yours ItkAff Date ItiriX I FEIN , i i , , , • . • . Only I if self-employed) -r . .• ,,,„„,- . L.,.... i and address wL414 tA4 441 Cil, &446,...i.st—Vci T ZIP ':.',, 1 Preparer's , I phone number II,- 1 , DO NOT MICR TC Rule 73B-10.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Ronda Noartreent of Reveoue COMPLETE and MAIL with your REPORT/PAYMENT. (", DOR USE ONLY .., T 11 I / / Please write your RT ACCOUNT NUMBER on check. Make check payable to: Rorida U.C.Fund , 1 1 Fin r- 11 1 I \\., POSTMARK OR HAND-DEL1VERY DATE ,,,,/ L RT ACCOUNT No. '2 II 9 12 I I 811 21 01 9 :43,4L 4. -t•'43: I U.S.Dollars 1 'Cents ....ur-41 -....“-----i.,-..."],----T---.....,E.---;.,--".""1 F.E.I.NUMBER 12.41 I . , ,, 11 11 H ii • GROSS WAGES [ 11 I I L2111-11111011 31, 21i ., 1 ES (From Line 2 above.) 1 I I I[ III il0 11 III II Il 1. i 11 Y Calaj — ....... AMOUNT ENCLOSED 1 11 I I I 11 IT I 1 il II 1 1 -11 riaj>.cio -.2- (From Line 9b above) 01 I 0 : :3 31 : : 31 33 , 3 .; 3: :. ; , >LI .32 ' - 'I- - — — Name altr-WALLACE BOOTH ELECTRIC PAYMENT FOR QUARTER 1---1 1 1 I 1 ni ENDING MM/YY i U131 1-11116 Mailing ii c)L4:35 EOGWOOD CT Address _AfARac) ISLAND, FL 34145 fai Check here if you are electing to r—I Check here if you transmitted City/St/21P , a Lu ! pay tax due in installments. I I funds electronically. C.,) ............ I Li A...co Li -- ie.., 9100 0 99999999 0068054031 7 5009999999 0000 4 111E111 111111I 11111111 IIIFlorida Department of Revenue Employer's Quarterly Report RT-6 LEmployers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due.j R.01/15 Use Black Ink to Complete This Form QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER 03li 1 1 H If f 11i 1 3 1 1 !1 2 i pill!, 61 i WALLACE BOOTH ELECTRIC i I 2i i 9 I 2 8', 2 0, 9 10.EMPLOYEE'S SOCIAL SECURITY NUMBER , ill.EMPLOYEE'S NAME(please print first twelve characters of last name and first) 1 12a. EMPLOYEE'S GROSS WAGES PAID THIS QUARTER , ! eight characters of first name in boxes) 1 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER Only the first$7,000 paid to each employee per calendar year is taxable. r---ri----H i_r---T--1_1 in -11 i L::,„, 1 li 1111-11-1Fri II 11 iril 11-111- 1 If 111. 1 r il h - 1 1 .il. 11 11 it li 11 it 1 11 IL.. 1 12a L1111_1311 1Lil.......j11J,,aLl. _H._ Name 1 1 11 11 ,1 i 1 1 11 1 Inlila1 I 1 1211 ! il 11 1-i 11 -1 11 11 11 1 ., . 1 1, ii 1 i 11 il ! I 11 I ! 1! 11 11 i I IL! 1 11 H H ; • II,..in! I 1 II II 11 H I: H H 11 II II 1 12a. ! il 11 II! JL!!!!!!(.........41i........JL.!!!.....,! :!. .... ...._..,.! •--;!---, .. , : '• •.• -• '• -•,, Fifs11 I il il 11 li 11 il 11 i Mirld:r., I ; i li. ?"4...Ale I 1 d i .11 ii H !i ! Initiai [ 1 12b. i 11 1 1 li 11 1 1 il i . :*--U---::/::-.=[lz---;''''''''.• i''''''.1:-----i .,,,[ il , 1 ii 11 I ! 11 II i 1 tI II 1 1 11 1 • •• !! H , N.dee i I !! H 1 !! H H H 11 H 11 1 12a. 1 11 !! I i H H ! I 11 ii 1. 1 11 !..........11 I I 1 1 I .... 1 __H.. I1 i! i ' !!'.• ''!!!!!!!'!! ',"; •••1`-•••• :! !• " - • --I!!=--!!!' ------'•••••••••••--/••••••-;••••••••••VII;•••••••••;•-•-•", -----•'! "••••-•! st 1 i il 11 il 11 II il ! midd!!!!!! fq(d!!!!!e i 1 1! 1 i 11 I! !!! i i i leivel• 1 i 12b. I ii .I I II 11 1. -1 I 11 ! 1 ir ..„.1 -11" 11 1 1 Las! 111 H H !nil If11 H 11 ITIri 1 II ,, , , II 11 , 1 11 ---, 11 I 1, ,, J 1 Ni.,:me 1 1 li il 11 11 il li 11 ii il ii i 12a 1 11 II 1 I li 11 I I I! ii ir 1 II I ......................„.......... Middle 1 I il 1 ; ;1 11 1 1 11 1 India' I 1210 . - , , : :! !i,--4!L..- ,- .-!1. j.• ' !!----! .. ........ I I if 1 i H i 1 II H 11 1 1••!!Et I 11 F 11 11 II II II 11 II II II 1 -11 II 11 11 11 1 I II II i !! ! !-: •11 i-I !!: !! 1! i ii .4 i .11.. i il Niatw-; [ II il. 11 1! 11 il ii 11 il !I 11. .1 12a. I 11 11 .1. ][ [ ...I3[ .,[.. II f. middie 1 i I II I 1 I II I • II I P4i[r]srr,l'e 1 11 11 11 1 11 11 11 i i• fft•1"......J1.._....1 L....!''...._ c.ii 12b.4 - L__. t..........il.........i 1 i......._.i..........1 L........i• ..........i!...........! ' 11 11 11 1_1 1 1.... 111 11 11 11 Las, I li 11 I: -1- 11 11 , , . ,. .. . ,,e i 1 ii 11 ii ii ii ii 11 ii li ii 1 12a I 1 11 I 1 11 1 1 II ii i [ 11 I ' '. '5' •i---i'".,,,,-::-:Pi:-----i i----i•r—'-•:. F-7 r----; ii- 1, 1, II , ,,,,d,,,,,, . . . .. .. . . .. , Nalv--;' 1 11. I! !! ] il ii 11 1 Initial i i 12b. ,... .. li; , 3i ,• , , ; II ! 11 11 I-I 11 -i I ii 11 i Name 1 i !I !! ii II !I il H I! 11 ii i 12a. i !i !i I 1 II II ! i ii II I. ( !! i ''4,4='; '...-=. --'-------' -------' " l'-'' ". );, '',.. .: 4- ;:....-....; First. [ .11-11- 11: il ii II II 1 "ode ' 1 1 I! I 1 11 11 1 r 11 1 , ,,,,, 1 ji 11 il I, 11 ILI: I India! I 12b . iii : 11 i Lii,s. i!!!! ,11 is!!!!!!!1: 11 ,F!!!!!!!!!1 l'H rl1-----,!- ,, -,, ----i nei I i I7 FIT F11-1117111 .11 ii 11 ii !! 'i !I ii 12a I'Irsf- [-IF u 111 11 11 11 LH midde 1 ! H r'i.drno 1 h 11 i Li i 11 11 i I I Initia i I 12b. . 1.. [ .: ...i i fl... .. ..i ii - 13a. Total Gross Wages(add Lines 12a only). Total this page only Include this and totals from additional pages in Line 2 on page 1. 1 i 1 11 LI 13b.Total Taxable Wages(add Lines 12b only). Total this page only. , 11 I , Include this and totals from additional pages in Line 4 on page 1. 1 , , , , :, 1 II I I 11 I ! 1 I 11 I ! R II !.. ;1 DO NOT -----------------DETACH-------------------------------------------------------------------------------------------------— Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. Z.: .. -._ Please save your instructions! Quarterly Report instructions(RT-6N/RTS-3)are only mailed with new accounts or when there are changes.If you misplace your instructions,you can download them from 41. 144 www.myflorida.com/dor .41.... ..... C4,4 Florida Department of Revenue Employer's Quarterly Report Use black ink. Example A-Handwritten Example B-Typed , Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. (- Example A ,: Example 8 ,,, rdirilEgilli4136111111(191 ilrolirilgY84lii ) T RT-6 , Use Black Ink to Complete This Form R.01/15 QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER 1 If- It o 61//1 f3Hl 1 ii 1of/2 1011111611 07/01/2016 I I 07/30/2016 I .0540 I I 2!19 II 21! 8i12ii 01 91 III I II 11 III 11 II Eli 1 IIIl 11 Do not make any changes If you do not have an account number,you to the pre-printed infixinalien on this Wm' F.E.Ia.reNUreciMBuEirFel d to register(see instructims). It changes are needed, ; 1 1 1 ..„F. .,,... „ I, request and complete an 1 9]i 7!-I 1 i; 1,13i131 21411 A Employer Account , `- , ,. .: s-1 Change Form(RTS-3). Fug mut usE 0tEy Kamm DATE i if i 1 '---- WALLACE BOOTH ELECTRIC SidMt be Completed , 1 Naft:e ' 1835 DOGWOOD CT 2 OcesvogsspaiddisquErter 1 ll 11 1 I 11 11 1 11 11 1 1 r 1 Address MARCO ISLAND, FL 34145 (mist tad dl pages) i i i ]i i i i 11 ! I H II i I 01 01 Cit St/ZIP 3. Excess wages paid the quarter 1 II if I [ I 11 1 1 11 li 1 1 1 - 1 yl (See instructions) 1 11 if 1 i 1 II 1 I 11 li I I 011 01 3 i L , ..)/........_,: L..... • L......_1,_, 4. Taxable wages paid this quarter i 1 1 i i i 1 T 1- i. r -- ; (See instructions) I II il ! I i il 1 1 li 1 1 1 01 0 Location 1 i - i r ..,r , i 9;._ i t • i. .; .. Address 5. Tax due rni il i !'--M Ci tS1/7_1P (Muitiply Line 4 by Tax Rate) 1 11 if i i 1 ii 1 i if i ! lop y/ , L 6. Penalty due " •' • ' "- f • •' ' " ' • .. .. . . . .. . . .. . . . 1. Enter the total number i 11 if 1 11 !! (See instructions) i if H f f , ff f I i„ .0 f . ,0 ....' : • of full-time and part-time 1st Month 1 1 i i 1 1 1 1 i 1 0, covered workers who 7Interest due . performed services during i --if iii f 112nd Mif (See instructions) , iiiiii ii1111111111 onth i 1 I i i i i i, I i 0 or received pay for the t I i ii _flit it. .1 i a. Installment fee payroll period including the (See instructions) 1 i i i i 12th of the month. 3rd Month i I i 1 i i i i . i I 1 10F• ..191 ii .ii j 9a. Total amount due (See instructions) 1 11 il 1 1 1 11 1 1 11 1 I I 0 0 17 Check if final return: ArnountEndesed . .. . . . . - . . .. • : , ,1 Al L.......1 Date operations ceased. 1 I I I/ I 1 1/ 1 il J1 i 1 9b. EES ), I ViUi (See instructions) I H H .1)e., ] il l't ii : I r.....] Check if you had out-of-state wages.Attach Employer's If you are filing as a sole proprietor,is this for pi f•-•-, 1 1 Quarterly Report for Out-of-State Taxable Wages(RT-6NF). ,',-,:' ., . -.'.. 1 ,._._, domestic(household)employment only? 1......_1 Yes L 1 No PTiarkk4,..•.:.:1-,..,...,n•..,:rms U,:.1, 'berl:,111,!s.sii p//. ,1 Clf...:Cia i la':-i ilavii read this riiiitiirn aii,1 tiiii..;faci3 stisTiii ari.: iii,i i:iiiii,iii.iiiiiiiiiis trail 71 iVi.I=1311.1ria Stri.ttilt:,151.. MietlaVES111111:111111F,1111111•11111811III1' - - i .. ,Title Sign here . V -_____ ww z,;c;,-,....., "-----"Ngiatlg"a'H''gaar----.4y,;,.-A&A,,,e, Date 1 Phones. „ Fax , 1 1 Preparer's 0,,, Preparer check i 1 Preparer's : 1 1 I. TT- 1 1 , . . 1 signature if self-employed i I SSN or PTIN Paid i preparers i Firms name(or yours Pli. _44.41C, Date 911 chi, FEIN only i if self-employed) and address tlit. Lt.4 4.-.... -4G-1- ZIP Ot 1 Preparer's lig,, i phone number 11111. 1 ----ildeilie, it 3443 DO NOT MACH TC Rule 73B-10.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Florida Diapartmeint of REivomie COMPLETE and MAIL with your REPORT/PAYMENT. /' DOR USE ONLY —\ T Please write your RT ACCOUNT NUMBER on check. r - I I / / Make check payable to: Ronda U.C.Fund : 1 II il 1 _ 1 11 1 ...........1 \\., POSTMARK OR HAND-DELIVERY DATE ,./ RT ACCOUNT NO. 2 1 19 11 2 i I 911 2 011 91 101:,. 1. ty I U.S.Dollars I I Cents I F.E.I.NUMBER i ,: , , ,, , ,, ,1 1, ,i i 2ii 7-111,1,i 3 il 311 2ii 41 14 GROSS WAGES " • " " " ' ' •• r " , - •• • • • •• ,, , • ,, ., : . - • ...,,. : , ...,, 1._.i.........j1......,_:.L.—.:—..., (From Line 2 above) ! il 1 i 1 11 11 I 1 11 1 I 1 0 0 AMOUNT ENCLOSED I II II I I II II I I It II I I I I (From Line 9b above) L 1 01 0 L..._... ....„...r __...i 7L___,L. - .7,._.....,i, ..,.......,• Warne ^-,... WALL:ACE BOOTH ELECTRIC PAYMENT FOR QUARTER 71 rai rn El . .74,... ENDING MM/YY I 0116 i-1 3116 1 Mailing 1.4,07 1836:DOGWOOD CT Address 43, i,,I1A10 ISLAND, FL 34145 71 Check here if you are electing to FT Check here if you transmitted . City/St/2i —....1 L i i pay tax due in installments. 1 ; funds electronically. 01 !i,.. ..< ....... FE,1,„z:741. Q__. L °— ,. 9100 0 99999999 0068054031 7 5009999999 0000 4 ...,_. c.-..z, c,,, 1111111111111111 IIIIII 111111 Florida Department of Revenue Employer's Quarterly Report RT-6 Employers are required to file quarterly tax/wage reports regardless of employment or whether anytaxes are due,meiR.01/15 PbY 4 Q' Y a9 P 9activity Use Black Ink to Complete This Form QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER L0 .._6..../,.._3i: 0/:2 ,i0:.1 •6� : WALLACEBOOTHELECTRIC 2 9 �,, B' 2 0 , 9 E 10.EMPLOYEES SOCIAL SECURITY NUMBER ' i 11.EMPLOYEE'S NAME(please print first twelve characters of last name and first; 112a. EMPLOYEES GROSS WAGES PAID THIS QUARTER .............._.................................................._......_....._......._._.................................................... I eight characters of first name in boxes) I 12b. EMPLOYEES TAXABLE WAGES PAID THIS QUARTER Only the first$7,000 pain to each empbyee per calendar year is taxable. i I i I l L i� t E _. , r ;: r. :..i;.j i: ..'xi:d W f; i ii i 3 I'<<. 12b. r l z.. xi .. 7 ..................... 1 ' ■ - miridie • I !: l Ei ± ,.n... � 12a. I i 1 F-1 ';sitt, r; ` i I.. .. 12b. ,1 t : r— ,: 11 1II i r� IName ,, - . 12a. :. fai xzit i;„€T:_ _ iie Ir;rai 126. ...........1......... .......... ......._ .......... is 1 11 .. , :, is :: :_ :: :: :: ;; :: ;; t : :: : ani. i .. iE ..i..., . 12a. :I ti i 11,---11 .... �R�id <:.rrE ; .i i :: Iri:i81 I 12b. _- E 1 II II m i .. el ii ei i eii f .. : . • .:. ._� :: .. : :: .. iii H .. ;.. t 1. ar,; ' 312b. # `..,ra. 12a. `.-.. i—; :i € i.. 1. €r14 12b. i 1 it't'S 11I*1 i li ii 1 ,.r .t. : I 12 E a I t Name 11_11 I ;LILT I i Ir`th,3i 12b. ' + i s • i I # 113a. Total Gross Wages(add Lines 12a only). Total this page only. i ii€ i, I + I ( i If I ie Include this and totals from additional pages in Line 2 on page 1. ' i i E I i iII 1 1. yc. is .■ € Li3b.Total Taxable Wages(add Lines 12b only). Total this page only. , Include this and totals from additional pages in Line 4 on page 1. .........E 9 !...... DO NOT _________--------DETACH Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Blcig. subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FLS`399-0189- and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice” for more information regarding the state and federal law governing the collection,use,or ..... release of SSNs,including authorized exceptions. Ca C iN Please save your instructions, cx44 - w col Quarterly Report instructions(RT-6N/RTS-3)are only mailed C3 c-;.:;• with new accounts or when there are changes.If you misplace cv your instructions,you can download them from www.myflorida.com/dor r Use black ink. Example A-Handwritten Example B-Typed Florida Department of Revenue Employer's Quarterly Report f' Example A Example a Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. 0J12;341156;789 r0 34 618$ 11`_ Use Black Ink to Come Teta FormT R.01/15 QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER nn 0 __9 1( 31; 0/ 2 ..0 3.i'i_.& :..._....._10/01/2016 10/30/2016 0540 12119 1211811 211 01, 9; 11111111111 III II III I I III II Do not make any changes If you do not have an account number,you to the pm-printed are required to (see instructions). information on this form. FE.I.NUMBER register It changes are needed, .r.........................._..._ll"- If,......_.., request and complete an I 2i I 7 1 ! 1 ' 3: 311 2 I 411 8 Employer Account I Change Form(RTS-3). FOR mai wow POSTMARK DATE ....E , WALLACE BOOTH ELECTRIC Reverse SideMu. c,r pi € .. ed _� 1 Name 1835 DOGWOOD CT a Ocesvzgas paid ttis quarter 1 11 II I I......... ......_., W4dilinc3 i Address MARCO ISLAND, FL 34145 mist tdtalall Cit SI/ZIP 3. Excess wages paid this quarter i-__._.,_......_,;.__....1 ,._.__..1......_.., . __.,r __.I (See instructions) i i i i0 0 4. Taxable r...__I:......_...--.._ -......_` wages paid this quarter :..I ......_, ,...._.i I i Locatio (See instructions) :€ 11 n : 0 0 Address 5. Tax due 1—i w_ r City/Stf ii (Multiply Line 4 by Tax Rate) I II 1 i___ __.W ■ ' 6. Penalty due ;....... .........7;..........,>........., ,... :.........T......._, ; ........., • • • 1. Enter the total number ....__..I,_.__._, ........1 ........................ .........i (See instructions) I 1 I 1 11 I 1 11 Iiiiil of full-time and part-time 1st Month 1 €i Ii I I 1 1 _..._....._........: .... .. _. __.)■ .__._..:..._.....; covered workers who _._ :.. .?i......... t.......... €._ ..! 7. Interest due ----- (See instructions) I € 11 I performed services during l i € € , i ,_....._.I .._.._' ....._.., II or received pay for the 2nd Month €' it 7!......._t_....... 101 8. Installment fee 1 payroll period including the ;---r._-.�> _ (Seeinstructions) —; 12th of the month. 3rd Month ':. €1 ' 'I Total amount due ! ,, i , instruct) i 0 _'- Check if final return: 1r' : _. _.........._._._ -.. _..... ........ _- Date operations ceased. ; 1 1 11 : €1 9b. Amount Enclosed (See instructions] I ...... , _.... . ... 1• •■ .......` Check if you had out-of-state wages.Attach Employer's -- Quarterly Report for Out-of-State Taxable Wages(RT-6NF). Ii If you are filing as a sole proprietor,is this for L.......: 1 , ; domestic(household)employment only? Yes I I No ,lfa z.liii'° 11 3 oGr Pena i es of pre-y.i e c...that_!lave raad this f _x/the facts steed in it at,?., .'-'-`_...o s 4.v3.7 Tip;Fierida Stfp ee) .,,,,... Title Sign here Phone (Fax iig,...... ... • 1 cer Date .. .............. - -- - ...........I Preparer's Preparer check 1 i E Preparer's € r et.. A SSN or PnN signature (�is IL _ /y1• / if self-employed;I , preparers Firm's self-employed)sname(or yours ............. ._. M �y r (�ofL�� Date 11� !�,j FEIN only ,_`'_r .. _ Paid � Pr er's �+i. 1._...;.....;....... :and address C. (y �r ZIP eP� �'��' ! ` IWa»___. 1 phone number I ) ........ __.... _...... _..... _.. _...._ _.._. DO NOT D-MACR TC Rule 73B-10.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14Flo r<ia L?e tarty:el`of Revenue COMPLE I E and MAIL with your REPORT/PAYMENT. i" DOR USE ONLY _. Please write your RT ACCOUNT NUMBER on check. / T Make check payable to: Rorida U.C.Fund \.____._PDSTMARK OR HAND-DELIVERY DATE ,% il 11 :,e,,,:, RT ACCOUNT NO. i 2 `g 2,1 8 2 0' 9 I : :...._ I U.S.Dollars I I Cents j EEL NUMBER GROSS WAGES � ;, €1_........ 211 -11 1111; 3 311 2 41 8 (From Line 2above.) _ :: i ! s 0'� Q, Lu -- AMOUNT ENCLOSED i (From Line 9b above.) _Li!I i ' 0; 0• Manic 41 1.3 WAL 4CE BOOTH ELECTRIC PAYMENT FOR QUARTER Fin - 7y • tg"1183 OGWOOD CT ENDING MM/YY ; 0€€9 —: 116 mailing , Address c t VIAR 'a0 ISLAND, FL 34145i----1 Check here if you are electing to Check here if you transmitted City/StZIP/ .tom< —w pay tax due in installments. I 1 funds electronically. L v 9100 0 99999999 0068054031 7 5009999999 0000 4 11 I 111111 I 1111 II I Florida Department of Revenue Employer's Quarterly Report RT-6 Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due,mi. R.01/15 Use Black Ink to amt This Form QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER i , 0 9 / 3 1^ 0/ 2 0 1 i 6( : WALLACE BOOTH ELECTRIC 2 .9� 2.,11 8ii 2 _0 !9 I. ill).EMPLOYEE'S SOCIAL SECURITY NUMBER 11.EMPLOYEE'S NAME(please pont first twelve characters of last name and firs! 12a. EMPLOYEES GROSS WAGES PAID THIS QUARTER eight characters of first name in boxes) 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER Only the first$7,000 paid to each employee per calendar yeas taxable. 1 ii ii 1 . , <.�mc: 2a € __.. ..< a ..........E ....:.........., il � , --- =- flame ,, ' I.: a. ` 12b. t _..; - ( . i �: €I ,, .,rr:c .... 12a it I N•,:i i E: :: is I. i. v:�me E: 1::::;a 12b. ' I ■ .......:........... is '' € i i I , n. i 122. ■ € i , , r . re : t... 12b. , : , ( r.;o. i ii is ,. ;, ,; t N.�.' :1 t11 1 'a.:rne ' i I I I Irr a' ' 12b. t • I . li r� W:ri is :1 :i. _I i ..idil li I , 1 1■ i...... i ! .. .. :. H. .. a :: ii ii 1 i II I 122< ' � Ei Ii i ,i .vul'rl' 122. ■ E i it «n w : •i i E' i ' First i e: ;: ; [—I e E v'.liY' e: art,A .......... ........... (...:.a: 12b. .. - [ : it � .. t e � �� is is _ i t :: : .w :x ..: : ,. :E _ E :hr= : : 1i 12a ,_:ice .._.!. i .........: i i midde C_ i ._ I i' 1 i I' { i 12b. 13a. Total Gross Wages(add Lines 12a only). Total this page only. i Include this and totals from additional pages in Line 2 on page 1. ,1.,...i:._._....:_......: _..__.., .........5 i........ ! . . .................... .__... ■ ........_i i._._, 9 13b.Total Taxable Wages(add Lines 12b only). Total this page only. '.......1,.......... '.........., Include this and totals from additional pages in Line 4 on page 1. DO NOT DETACH Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119,071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. r-- lsi --- -- Please save your instructions! Quarterly Report instructions(RT-6N/RTS-3)are only mailed •Ct with new accounts or when there are changes.If you misplace — your instructions,you can download them from ii " = Lei www.myflorida.com/dor CL ca 0101101111111111111111111010111Florida Department of Revenue 8436 Employer's Quarterly Report Continuation Sheet RT-6A Employers are required to file quarterly tax/wage reports regardless of employment activity or whether R.01/15 any taxes are due. Page 1 of 1 FLWA0102 02/06/15 FW2 EMPLOYER'S NAME WALLACE BOOTH ELECTRIC 1214 0 AGUILAR TOMAS V 1126400 0 0 0 0 ALEXANDER HARRY J 1408000 0 0 0 0 COBRERA EDURADO 708000 0 0 0 0 LUNA EFRAIN 829800 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 " o 0 1.4,1::,---ci) ., 0 0 0 0 { , 0 0 0 0 £ .�L CI_ 0 0 0 C3. W 14.3 C3 0 0 0 4072200 N 0 0 0 000 0 0 0 4072200 0 0 0 0 Social security numbers(SSNs)are used by Florida Department of Revenue as unique identifiers for the administration of Florida's taxes.SSNs Rule 73B-10.037 obtained for tax administration purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not subject to disclosure as Florida Administrative Code public records.Collection of your SSN is authorized under state and federal law.Visit our Internet site at www.myflorida.com/dor and select "Privacy Notice"for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. Visit us at www.53.corn 63-9171/670 1011 WALLACE R BOOTH 1835DOGWOOD DR. q - MARCO ISLAND,FL 34145 Date Pay derr oof e 1� t?f7 4—i 'UU -.E-)UU 8 F k •1 6llars � FIFTH THIRD BANK AP --- LOL1 2118` SS Florida Department of Revenue Employer's Quarterly Report Use black ink. Example A-Handwritten Example B-Typed Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. COMMCIEbannALEIEE ODDIMPIWB OR) RT-6 Use Black Ink to Complete This Form all R.0 • QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER o 1 3 / 3 1/12 0 1 1 04/01/2015 04/30/2015 .0540 2 9 2 81 2 0 ] 9 Do not make any changes If you do not have an account number,you 11111111111 IIIIIIIIIIIIIIIIIIIIII to the pre-printed are required to register(see instructions). Information on this form. F.E.I.NUMBER If changes are needed, —1 request and complete an 2 7 -I 1 1 3 4 8 Employer Account 31 Change Fonn(RTS-3). Elm mut law,/pawn DATE WALLACE BOOTH ELECTRIC Reverse Side Must be Completed / / I 1 Name I 1835 DOGWOOD CT 2. Gross wages paid this quarter Maiing I Address I MARCO ISLAND, FL 34145 (Must to3 5 3 6 0 tal all pages) 7 7 . 0 0 3. Excess wages paid this quarter City/St/ZIP (See instructions) /7—17 6 0 • 0 0 7 4. Taxable wages paid this quarter (See instructions) 2 7 6 0 0 . 0 0 Location I Address I 5. Tax due _ City/St/ZIP (Multiply Line 4 by Tax Rate) 1 4 19 I 0 • 4 Oa 1J..1 Cr) 6. Penalty due 1 1 oi 0 c 0 1. Enter the total nurnbe rt.; (See instructions) 31 of full-time ane, L -- 1 stAlronth 4 covered work,l7''' ':' u, 3 7. Interest due 2nrMonth .S' 1,..., (See instructions) I 1 1 1 1 Ped°rmed -.'"-r•-•,; 4ci1l3IR 0 or received.-, . •;" 7 i 4 I 8. Installment fee payroll i:..•i, ', ,„. i I-- CTI (See instructions) 12th of the kti,--4. rO'Month 4 a 9a. Total amount due I I I 0_ k r CL Li (See instructions) Check if finaListurn: Cor / / 9b. AmountEnclosed ____ Date operate&cease . (See instructions) [•17L14S-1. 0 Check if you had out-o fate wages.Attach Employer's If you are filing as a sole proprietor,is this for Quarterly Report for Out-of-State Taxable Wages(RT-6NF). i: ''- —-i• domestic(household)employment only? Yes No Under penalties of penury,I declare that I have read this return and the tam stated; tare true(secttons 443.1716),Florida Statutes) 41 Sign here sto ot,:ro o officer Date Phone Title ( Pet.,58 at eft,/1*--- I FaxI Prepare(check Pmparer's Paid 0. 1 signature r's 0, klit„.4./....S c,..A..... ti., if self-employed SSN or PTIN preparers Firm's name(or yours MA, 4c4i Date "Zig FEIN only • If self-employed) and address 4 if I G (AAA.CA Cra•1 ZIP Preparer's Al Aril, 4C 3•( ,i 7 phone number VI DO NOT TC Rule 73B-10.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Florida Department of Revenue COMPLETE and MAIL with your REPORT/PAYMENT. i' DOR USE ONLY -, T Please write your RT ACCOUNT NUMBER on check. / / Make check payable to: Florida U.C.Fund \\,,,,, POSTMARK OR HAND-DELIVERY DATE RT ACCOUNT NO. 2 9 2 8 2 01 9 I U.S.Dollars I I Cents I F.E.I.NUMBER 2 7- l GROSS WAGES —11 I 1 I 3 3 2 4 E (From Line 2 above.) i ......._ 13 5 3 6 rd 010 1 7 . AMOUNT ENCLOSED I — (From Line 9b above.) 171 I 1-56)111"1 E JO 0 Name WALLACE BOOTH ELECTRIC PAYMENT FOR QUARTER 1 I Mailing 1835 DOGWOOD CT ENDING MM/YY 0 3 - 1 5 Address MARCO ISLAND, FL 34145 Check here if you are electing to Check here if you transmitted City/StJZIP pay tax due in installments, funds electronically. L _ 9100 0 99999999 00L8054031 7 5009999999 0000 4 III 1111111111 III II II VIII III II) L Employers Florida Department of Revenue Employer's Quarterly Report RT-6 are required to file quarterly tax/wage reports regardless of employment activityor whether any taxes are due. R.01/15 Use Black Ink to Complete This Form • QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER o 3 / 3 I 1 / 2 0 1 n WALLACE BOOTH ELECTRIC 2 9 2 8 2 0 9 • 10.EMPLOYEE'S SOCIAL SECURITY NUMBER 11.EMPLOYEE'S NAME(please print first twelve characters of last name and first 12a. EMPLOYEE'S GROSS WAGES PAID THIS QUARTER eight characters of first name in boxes) 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER Only the fust$7,000 paid to each employee per calendar year is taxable. Last Name AQUJLAR 12a. I3 9, 6 8 1 0 ■ 0 0 First Middle 7� O O ■ Name 1 T H O M A S Initial 12b. Oi — LaM ame I AI L EX ANDER I I 12a. 3 1 ]� 8 8 O O I OI First Middle -- Name H A R I R Y Initial 12b. 117 0 0 0 ■ 0 101 Last Name CABRERA 12a. 6 6 0 0 r 0 0 First IMiddle ' Name E D U A R D 0 Initial 12b. 6 6 0 O . 0 01 Last ■I0 I 1 Firm Middle Name EFRAIN Initial 12b. 7 ' 0 ! 01 d. 0 0 I I — 1—i Last I II Name 12a. ■ First Middle I I 11■ 1 Name Initial 1211 Last I Name 1 I 12a. I 9 / I■ Fiast Mi - ,I Name Initial 12b. r Last — r( r, Name 1 12a. I ! ,, r 1 First Middle 2 Name Initial 12b. r Last .. r. Name [ 12a. 11 ■ First I II I Middle Name Initial 12b. ■ 13a. Total Gross Wages(add Lines 12a only). Total this page only. Include this and totals from additional pages in Line 2 on page 1. ! 3 L y 3 6 0 a 0 110I L 13b.Total Taxable Wages(add Lines 12b only). Total this page only. Include this and totals from additional pages in Line 4 on page 1. 2 7 6 0 r 0 0 DO NOT Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. >O z ,c Please save your instructions! zc LL1. j Quarterly Report instructions(RT-6N/RTS-3)are only mailed LI-I CL _ON with new accounts or when there are changes.If you misplace :' . your instructions,you can download them from a. La.! LIJ GO www.myflorida.com/dor cv a Florida Department of Revenue Employer's Quarterly Report Use black ink. Example A-Handwritten Example B-Typed Employers are re required to file quarterly tax/wage e re orts regardless of em I employment activity or whether anytaxes are due. �. q q 'IY 9 PP%` tY ! or 2134i789i 01 j,,p6--89 RT-6 UseBlack Ink Com This Form T R.01/15 ' QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER 1 0 61/13 / 3 l, 01/2 2 [0 111 5 07/01/2015 07/31/2015 1 .0540 ! ,1211911211811. __0.1 9; _11.11..... III II IIIII I II III II II IIIII III if you do not to veanacceeinstmber,you to the pre-printed are required to register(see it num tion). information on this form. EE.I.NUMBER If changes are needed, ....._._, ........, ,11.11._.,i..........._........;,_........_.........1 11_11..,:_........, request and complete an ;' 7 - 1 I 1 1 Employer Account ;..-2::... ; :._ 3, .. 4 8 ; Change Form(RTS-3). Epp DFRGAL'BE E oPDSTTA J(DATE :......... ..........: 1.1.11.. .......... �_......_;,..........; r WALLACE BOOTH ELECTRIC Re efse Side Must e mpleted ,•1 I Name 1835 DOGWOOD CT z GI:savages peidthisquxter ......_._...............__, ,_._....,......_.., ...._..., r...._., .... ,... , , Mailing j (M.r3total all pages) 3;; 6 6 8 I'0 1 0 0 MARCO ISLAND, FL 34145 i . �._......<......._.: tlddns, 3. Excess wages paid this quarter ,r........, ', ,, , City/St/ZIPl� H (See instructions) ;; s 3 '6 2 81 0 OH0 _ 4. Taxable wages1111_._.,1.111_._ _ 1111.:_1111.. paid this quarter (See instructions) : H I i4ii 01 Q i 0!.1 01 Ltm atiort Address 5. Tax due ' i — ' ' i' City'S€la IP tai (Muhiply Line 4 by Tax Rate) 2 ! 1;.5 t 0 6. Penalty due 1 r,1 1. Enter the tot beer161a 1 (See instructions) (� of full-ti ':rt-time •st Month I 4 j ........... ..... 7. Interest due �' ' v■ covere+r afi XC ?. (See instructions) perfor �u_..wring i 1 or recalue9.a +. - 2nd Month1. 4 6. Installment fee i -payrol peT„ n*Ing ICI �---- — --1 (See instructions) 12th�' . ' 3rd Month ' 1 #...,: Q. L._.._ :._. 1 1111 4_i 9a. Total amount due � 1 I--—_ w _ r11.1.1..... .-..-. _....._ _ 11...._._.11............. `::..._.. ............. 177----- _— -......... , _ cl -- Lt. instructions /17e. C( [ Check Iteral returrC/) 1 , :: ,t b. Amount Enclosed I.._...1 Date o tions akieed. ; : ,t ' ? li i Seeinstructions) instructions Check if you had 65ttof-state wages.Attach Employer's -•.. ,• -: Quarterly Report for Out-of-State Taxable Wages(RT-6NF). • If you are filing as a sole proprietor,is this for __ domestic(household)employment only. ,___Yes i___No a y._.I? ..d perjury, ,lea .,.s_ .i; ... J.3 .iS '•1 h ..u_>.a.G Tin' ,-C,i.,.S44..3.1.11( . 3 t4 Statutes, , � Title Sign here Date Phone"e :Fax Pre ers Preparer check Preparer's Paid sig ureif self-employed _.. A SSN or PTIN I preparers ,Firm's name for yours �' I FEIN - i MSP_. �� Date '444 i i I only if self-employed) _. and address 441,c ________._- W _.ey ZIP T 1 Preparer's V phone number t - DO NOT DETACH TC Rule 731110.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Florida Department of Reveilue COMPLETE and MAIL with your REPORT/PAYMENT, i" DOR USE ONLY �'\ Please write your RT ACCOUNT NUMBER on check. -r _ Make check payable to: Florida U.C.Fund �., POSTMARK OR HAND-DEUV'EAY DATE „,,,/ _ ..._.... .. ., _..; 1111.. RT ACCOUNT NO. 12 9 1 2 8 12 Oil 19 ____ I U.S.Dollars I I Cents i F.E.I.NUMBER ! '- i l GROSS WAGES - ,I.........., 2 : 7 1 1 ! 311 3, 2; 4' 8 li 0 �.....:. ;; 1111; __1111: (From Line 2 above) 3 6 '6 ' 8 d• ;0 . I E :_111_1..;:1___111: 11_11 i i__;• :...__.......__....: AMOUNT ENCLOSED 1 H I _..._. :_..__...;......._,1 1111_. ,...._...I 11...._..__......._. (From Line 9b above) 1_. ;; 'i 2 4.■ (sQ' Name t WALLACE BOOTH ELECTRIC PAYMENT FOR QUARTER i '' I I Mailing 1835 DOGWOOD CT ENDING MMM' 0 6''l 5 Address MARCO ISLAND, FL 34145 '—"i Check here if you are electing to __ Check here if you transmitted City/St/ZIP L pay tax due in installments. I i funds electronically. L 9100 0 99999999 0061054031 5009999999 0000 4 7 111111 I 11111L Florida Department of Revenue Employer's Quarterly Report RT-6 0.1 REmployers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. R.01!15 Use Black Ink to Complete This Form • QUARTER ENDING EMPLOYERS NAME RT ACCOUNT NUMBER 011 61/1 311 0 l f 211, 0 I 1 15 i WALLACE BOOTH ELECTRIC I i 211 9 I ._.2.11..811 2 0 11 11 1 .9 10.EMPLOYEE'S SOCIAL SECURITY NUMBER 11.EMPLOYEE'S NAME(please print first twelve characters ot last name area first, `12a. EMPLOYEE'S GROSS WAGES PAID THIS QUARTER eight characters of first name in boxes) i I 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER • Only the first 57,000 paid to each employee per calender year s taxable. me p.E 4 U La i A R �. tza �! ....11..110_1,7,5.116H. p. 1 . 0, E f ... I Tixi' O MEA s 1 .1.. ' 1 ` I 01 0 ' 0 0 virr{ 1 Ail L E XIIA. N .D :E 11R .i i 12a. 1 1 10 0 '0 1. 1...011 01 E > rn k.i[ Al R ...R.11.31[...... II I':a: 1 12b. ' 01 00. i0 0: ':,<.r:> I C,i A j:Bil R i E 11R 11A 11 11 11 11 ii 1 12a ' 1 1 11 1 T 12 110 0 1 1 0 0 ■ `ifs'; 11 1. �r'c E D U A[ R D _0 si ; 12b. i 4 i 0 ; 0 b 0 date L ( Ui€N :A , E, ' 12a. 7 1912.... '0.1■ ' 0 0: Name I E iF 11 R 11A III 11IsT II 11 1 irilial 1 12b. Lid Cr> —ix ix. Narris. 11 i I s. 12b. 1_11..........1 1 i "CL. . -•- •t• � - - ti yy;` . c . ' i 1 11 1.114. 1-1m-1 E i N':rrc € 11_,11 11 IL ii 11 1, i 12a. II 14.1 111Irst I 11 ii ii a- •CG fi E € a 12b. ■ I 11 II i t � II I E. ii is '. 1-1 i s 1: E i .a,3Me,j it 7 It K 1 12a. ,._,._, • i I,..........11 E 1 II 113a. Total Gross Wages(add Lines 12a only). Total this page only. ii ii ii i 1 II ii j i I1 ` ' . : I Include this and totals from additional pages in Line 2 on page 1. .1 3 0 6 8!' 0 . 1 0i1 0 13b.Total Taxable Wages(add Lines 12b only). Total this page only. _ : L Include this and totals from additional pages in Line 4 on page 1. L. l �4 i. ` Q■ 0 !0 DO NOT Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. Please save your instructions! Quarterly Report instructions(RT-6N/RTS-3)are only mailed with new accounts or when there are changes.If you misplace your instructions,you can download them from www.myflorida.com/dor Florida Department of Revenue Employer's Quarterly Report - Use black ink. Example A-Handwritten Example B-Typed Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due. zExample A Example B, , '' [ br 1i 2 3 4 31141 1181191 nrolf2iTO gip T RT-6 Use Black Ink to Complete This Form . R.01/15 • QUARTER ENDING DUE DATE PENALTY AFTER DATE TA)(RATE FIT ACCOUNT NUMBER . .. , 1-0-11-;1/13 ii 01/2 110 111 1 10/01/2015 1 I 10/31/2015 I [ .0540 • , i 12119 1211811 ,:: i 2 0I • Ill lig 111111111 H111111 Do not make any changes If you do not have an account number,you to the pre-printed are required to register(see instructions). information on this form. F.E.I.NUMBER If changes are needed, f .. 1 . -r- •!, request and complete an 1 .)11 71.. .1 i l .1 ! .1!, .a!! ..1! A I I loi Employer Account Change Form(RTS-3), FOR EfficiAL us E Amy mom DATE ' " "• • 1 i • I— WALLACE BOOTH ELECTRIC Reverse Side Must be Completed 1 j 1 /1 i 1 11 11_1u Li Name 1835 DOGWOOD CT 2 Gross vagas paidliisquater 1'11'3114'gMARCO ISLAND, FL 34145 Address Ntst total all paigas) I 1 i i 1 i i 3 6 ! 4 2 I 0 1• 1 01! 0 /ZIP 3. Excess wages paid this quarter City/St (See instructions) 1 I l 11 1 I 13 Il 6 14112 0 1 oil 0 4. Taxable wages paid this quarter 1 if ir 11 1 II 11 II i I [ 11 I (See instnittions) 1 11 1[ .171.. 1 II 17[0i0i I qa [01[0 Lor;ation CV Ad dreb::,! '' Cr) 5. Tax due rn r""-1i ! i -Th : i 1- 1 i- ial 1-1 71 (Multiply Line 4 by Tax Rate) 1 1! 11 1 1 i H 1 1 110 l 01. 0 Ho cftyistivp :- „....._.„3: _........_„ .._, •:. cz) , ....... 6. Penalty due • - - : : : : : : :: : • • : : i 1 1 1 1 li 1 2_l 101 6110 ! (See instructions) 1. Enne-e/131-c, rnberZC i 11 ! I 1 il 11 I of• 4i..4.ifiZlrt-tirgr 1st Month 1 11 1 1 ! i! !i 4 1 &a 7. Interest due L.........II.......... I..........17 I..........11..........“..........1 I 11 li 1 I 11711 I I 1[71 1 1 I 1 cokebp 070 rs who (See instructions) .-- -- - dunno 1 1E7 r---1 1---11--1 El 11 II .1,[._ il II ill.... it it ,. ......4, 1 1 1 I 1 I i 1 i i i o -,- -:24t!or the 2nd Month 4 I 8. Installment fee ..!,fibeilod includtthe (See instructions) ! !! !! !! ! 12th caw month. 3rd Month 1 11 !! 1 1 11 11 4 i Col i i! i f i I !! !! ] !„.);?!.. Li t i t 1 t _IIi it H i 9a Total amount due CZt x.dc> (See instructions) l II li 1 i 11 ii 1 ! .! 1111 p ,lo , , '--, Check if final rettaxi: I I i I /i I I/i 1 i i 1 ii i 9b. Arnaud Enclosed ! - -,!- ” • - • • ! i I I f I 1 1 Date operationfNased. l I I 1/ i II i i i, I i !I I (See instructions) I 11 11 III I 11 11115701 011°1 ' !I Check if you had out-of-state wages.Attach Employer's i : If you are filing as a sole proprietor,is this for i i i 1 I I Quarterly Report for Out-of-State Taxable Wages(81-6NF). domestic(household)employment only? • ,_...1 Yes i_j No ,,i,,,.-!--,,,,,-!!!,,!!!!,,i!!!!!!!!!!, •.,--!,,,,,,,',,,,,,,,•:-,,,, Lt!tt-K%,rjen'frtma 01Periuri, Oe(-;i'arEI thai'itave read ft.it rm.-ft a,lci thc,.!acts atatfxi,r!it aral,,Je. fic.:ns ar,,1.171!.5),Rotida Statufe . .......... -------- Sign here l,1____ Title --- 04, , I r SKtflatur of o'n,s,',-.,r Date I Phone) ' . 'Fax :•• ..: 1 1 I , I i t Preparer check F-1 I Preparers 1 Preparers Op, st04.414., • '' FrnN0 III signature if serf-employed ! il SSN or " ii i 1 Paid i ; y preparers i Firm's name(or yours ta.4C , oate 1 ilk& 1 FEIN . •I I 1 i , U :only 1 if self-employed) 444/ aft., .ki,Co ZIP ibi. --1- !Preparers " , I 1 phone number I i and address • Lip lit 74-11- DO NOT ---------------------------------------------------------------------------------------------brtAca------------------- TC Rule 73B-10.037 Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Fioricia D6partment of Revenue COMPLE I band MAIL with your REPORT/PAYMENT. 7.- DOR USE ONLY Please write your RT ACCOUNT NUMBER on check. T Make check payable to: Honda=Rind \\ POSTMARK OR HARD DELIVERY DATE ,./ RT ACCOUNT NO. i2 i!9 II 2 i i• 8 i i 2 , 0i, 91 1 U.S.Dollars I I Cents I 1-71-11-7!"-"""i r."--i 1!!-I I-""""i F.E.I.NUMBER I 1i I i i i ii !I ii I i 1 i 1 GROSS WAGES E-1II L211 7-1]. illii 3ii 31[ 2ii ii a (From Line 2 above.) I II ii 1 i ii3 !!6I 14 ii 21i 0• i0 1[01 • ' ! .... ! AMOUNT ENCLOSED " : : ..„..... (From Line 9b above -- yi_..._ .) 11 1 i 11-11 I IX. 1:'$":, o—l b lio I -. 111 L 11 il I. , . ,_ ____, .11 -- -7,....—t. .:.. — .... Name WALLACE BOOTH ELECTRIC PAYMENT FOR QUARTER . 1 i I I l 1 I Oil ll 1151 Malting 1835 DOGWOOD CT ENDING MM/YY Addres 1 MARCO ISLAND, FL 34145 Ii Check here if you are electing to Ti Check here if you transmitted City/St/ZIP 1 !. i pay tax due in installments. I I funds electronically. ,........i L I- 9100 0 99999999 0068054031 7 5009999999 0000 4 III I II I II I II II III 111 III I Florida Department of Revenue Employer's Quarterly ReportRT-6 L Employers arerequired to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due, R.01/15 Use Black Ink to Complete This.Form QUARTER ENDING EMPLOYERS NAME RT ACCOUNT NUMBER 0 9 3 1 1 0: O + ; WALLACE BOOTH ELECTRIC 2 9 21 B 2 0 i 9 �, ;: 2, it { ! :: ... H .t..• . • 10.EMPLOYEES SOCIAL SECURITY NUMBER €11.EMPLOYEE'S NAME(please print first twelve characters of last name and first; 12a. EMPLOYEE'S GROSS WAGES PAID THIS QUARTER eight characters of first name in boxes) 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER Only the first$7,000 paid to each employee per calendar year is taxable. rE ' A Qi U Lf Ail R1 ii . _. ..._ i ; 12aJ_J _ .1, 1 1(1,1 4 E 4 0, l ()Jai 0 ;1111.... i T j H I I O I i M I A I I S i !, I I u: 12b. 0 0' 0. 0 0 N:,r: A l LH E X l A N I D E R 11 11 1 1, • 1111... t. 12a ' _11. 4 3 i 0 0 ■ 0 0 .rr:E: 1 H I A! .R..._R I Y„ 1 11 i InItIai I 12b. i ...!E... 9 0 U U. i 0.: 0; ..................... ..... 1111... 1111.: 1111..; ; _ .._, - -. rrs, Si D U A,, R D :O I i 12b. i i• 0 0 0 �p i 0 SiII 11 1 �......._1 i i 6 14118 0 . j 0 O i _ Name I L: U N A 12a E a,, E 1 F R A...l I• N ( a a 12b. ! ■ 1 11 iii I :r...._.. l: i 3`f ''" ,......;t...ii H i ii t ... I 1. 12a ,... i i 9 ■ mak...:` CR.. i i {.tie { Ct. CO '�•.rrie Initial p 12b. I.. I ,■ 1111.:_1111. 1 l { 3 :: I E.....:.:_ .. .. +aa:s .1. 1111 1111. ........ "5 dn_ -_ e : ii !` ' I Nairn; In; 12b. ___._. ..........:......, ._........ ,.........._,..._..... 1111._. . ,... -- _ - -- .........:. .111.1_., t=. s: ;, f ............. 111__1,..._.......... I :: .. .. :: 1111. ii :: .. .. is i t.. 12 .: ;. .. .d._ .. .. .. � _ 1111 7,...�::._..._.. ,.....,,._,......,........__.. '� .: ,1111: _, 1111 r... 1111:.' ._:..: ■ ii r jj _.__.......:,.....: „_11_1�......_! _. ..,.....�..._................. j 1 1,111 1::.....:1 i......: i i' . 11 1 • 11 1 11 lriiiiai :1.11.1: 12b. , 1111 ,1111..ii If 1 i if I : C ! II i 11 11 il il II il I( 'i i l i£ 12a. 1 ,,h Y .E s ;.......: .; _1111..,t. _, ,....._.._«1111.. ;r .._: ,� - .5.=!=!:=11;:=71-: ,1111. is ;a.?rre € h t3 .. 12b. 1111. ■ i _... .._. jj I :..-._.,i...._...J i_.__.::........1...._..,.::.._.,..,..:t...„...::........... t„ri 1111.....1111. 1111. ....._ ..... 1111. 1111.. i� [i 13a. Total Gross Wages(add Lines 12a only). Total this page only. 11 11 II ' ° Includethis andtotalsfrom additional pages in Line 2 on page 1. 1 3 ` , t.......i� 1 :1111 :�.i 4..._....:: 2........: 0 . 01 a •..........{........... 1111..__.�..........!_..._....� _1111 ........... L 13b.Total Taxable Wages(add Lines 12b only). Total this page only. Include this and totals from additional pages in Line 4 on page 1, j':. 0 I 0II 0• (0 01 DO NOT DETACH Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myflorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. Please save your instructions! Quarterly Report instructions(RT-6N/RTS-3)are only mailed with new accounts or when there are changes.If you misplace your instructions,you can download them from www.myflorida.com/dor Florida Department of Revenue Employer's Quarterly Report Use black ink. Example A-Handwritten Example B-Typed Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any twces are due. Vi1121134 '547814 Flioit''31 €7,-i3i) TT R -6 .• • Use Black Ink to Complete This Form R.01/15 QUARTER ENDING DUE DATE PENALTY AFTER DATE TAX RATE RT ACCOUNT NUMBER , . 1 1 I i 11-11 11 11 in 1 1-11-1111-;1 i if 1—"3 :rill I 1: 11 0 hl i!irs 1 01/02/2016 1 i 01/31/2016 1 1 .0540 I 1 2 11911 2 11 8 H 2 11 0 11 9 ,..., ii....._,/ , -, if • III II 1IIII I 11 III 11 II III III Il Do not make any changes If you do not have an account number,you to the pre-printed are required to register(see instructions). information on this form F.E.I.NUMBER If changes are needed, , 11 tir ii il 11 tt it i request and complete an -ii ill iiii 3i 31, 21 41i 8 Employer Account ,zi7. . . ..., , -, , - Change Form(RTS-3). Ea aux usE cay mum au Reverse Side Must be Corripieted I 11 it I i / 1 11 11 i WALLACE BOOTH ELECTRIC , ; i H Name 1835 DOGWOOD CT a CfosswagEs paid this c;uarter r ,, -i r Mailing Address MARCO ISLAND, FL 34145 (M.st fetal all pages) 1 11 il 1 I 1 1 1 1 511 2 ji 0 1• I Oil 0 Ci ty/SZ3. Excess wages paid Ws quarter tIIP (See instructions) I 11 11 i 1,,..,_ ,1111 1115112 1 1 Oil 0 L.,_,,,t.,—j, ,yL__,..,, •: y: • ...m 01 i• rni} ,_ 4. Taxable wages paid this quarter i 11 11 i I - ir I I 11 I I I li Lu Csi (See instructions) 1 1 1011 01 11)• i. t I Oli 01 Location --.. ICY) i 11 it . ,.. ,, IL i Address 11.1±-" .. 5. Tax due1 111 ,1111111111111_ 11 Ci ty/StiZIP IQ C:) L p.t...t occ (Muttiply Line 4 by Tax Rate) 6. Penalty due 1 11 11 1 1 i 11 11 llo loi.p pl . •• ,. , • • . . . .. .. : : : : : : :" 3 I i3 1. Enter theitetelornberl ; ,; ,; t . - .. (See instructions) 1 11 II 1 I l 11 1 1/ .r) 1,5 0161 ii 1 11 II of full-ti -..,rzarClitne ctist Month 1 I t I 1 i 1 t I i 3 covered. il.4E,,,wgd: ___ • - •. ... 7. Interest due 1 ii 1! 1 1 Fit (See instructions) 1 li 11 I I 1 11 I 1 11 I 1 i 11 I perfor v.T.riQeatiring C 2nd Month i i A orreceved.7orhe L i1i2 L. 3• 3 33. 3 g. Installment fee i i i i t i payroll penow,luding thr,„,#, (See instructions) i t I i t I i ii i i it 11 1• t t t t 12th of the im h. ....4m3rd Month i i i7i _ft I 1 i 9a, Total amount due . t, ., . . 1 , , r-1, , ri r—., I ,, 1, i , , , ,, (See instructions) I 11 it 1 1 i 11 1 I 110 1 Oi.0 110 X Check if final return: 1 11 1/11 I i/I ., ., . , . . , 9b. knogritEnclosed .. .. . . . . . . .. . . , • . 1_...1 Date operations ceased. l 11 1 1 i i 1 ji ii 1... i . i . - - i -1 :e."-, 0 t 1 I (See instructions) 1 11 it , , i : , ti 4 ) : t 61 1"---1 Check if you had out-of-state wages.Attach Employer's Quarterly Report for Out-of-State Taxable Wages(RT-6NF). ill fIt 11111,/1:„.1 If you are filing as a sole proprietor,is this for 1 • I t t it.ti, it, ii:iti domestic(household)employment only? Yes L...,1No W.,414J4 zad-&-..•:tt I Title 0:. Sign here Phone „ ,, IFa+ ( , . --,..i.g;mt...4.,?.<•„t s..r,:re Date V i Preparer's .-.--7 Preparer check i 1 i Preparer's 1 signature •IJ6434444I if self-employed 1 i SSN or PTIN Paid preparers I Firm's name(or yours mtweA4FEIN . . - Date efirk, . . .i.._i j i ,I, only i if self-empioyed) i .- r-- and address 4.4 31- ulf tan &a.' ZIP i Preparers phone number 4:ir DO NOT DETACR TC t Rule 73B-10.037 ' Employer's Quarterly Report Payment Coupon RT-6 Florida Administrative Code R.01/15 Effective Date 11/14 Florida DOPartMent Of RevenUe COMPLETE and MNL with your REPOFIT/PAYMENT. 7- DOR USE ONLY T Please write your RT ACCOUNT NUMBER on check. 1 / Make check payable to: Florida U.C.Fund i 1 11 ..11 I 1 11 1 I \\,, POS'INARK OR HAND-DELI VERY DATE ,,/ : 11 it 11 ii ii RT ACCOUNT NO. 2 !1 9 1 1 2 1 i 8112 01 9 1 1 1 I U.S.Dollars I I Cents I GROSS WAGES r II ir 1 1 II II 1 1 II I 1 I I I F.E.I.NUMBER 1 211 1'11111 131i 311 211 41 Ei .._......._... ,.__1. . .,....._a,......_11.—.--, (From Line 2 above.) 1 11 1 I I 111 II 1 151121 q• lo 1 0 • AMOUNT ENCLOSED I I I If 1 i 11 li I 1.i if -11. i 11 1 (From Line 9b above.) I 11 II I I 11 11 I li 12 IIYI P 1[0 Name WALLACE BOOTH ELECTRIC PAYMENT FOR QUARTER ENDING MM/YY 1111 Ll ii 51 Mailing ! 1835 DOGWOOD CT Address MARCO ISLAND, FL 34145 r 7 Check here if you are electing to 17 Check here if you transmitted City/StRIP - I i pay tax due in installments. 1 1 funds electronically. i........... 9100 0 99999999 0068054031 7 5009999999 0000 4 11 II ll I I II I 111111 I II IFlorida Department of Revenue Employer's Quarterly Report L Employers are required to Be quarterly tax/wage reports regardless of employment activity or whether any taxes are due.1 RT-6 R.01/15 Use Black Ink to Complete:This Form a QUARTER ENDING EMPLOYER'S NAME RT ACCOUNT NUMBER r .,1111 _ ___... -_. _... _._._._... 1111.... _1111...... ..._... I 1 2 /k 31 1 � 2 ()Ill_ 5 WALLACE BOOTH ELECTRIC 2 91 2; 8 2 1 0 1 9 1111.. ... ._.... 1111. ......... ........ ............. 1111 3 1111. ... 1111 .......... ... ........ ._ 1111. 10.EMPLOYEE'S SOCIAL SECURITY NUMBER 11.EMPLOYEE'S NAME(please print first twelve characters of last name and first: ,12a. EMPLOYEE'S GROSS WAGES PAID THIS QUARTER eight characters of first name in boxes) 1 12b. EMPLOYEE'S TAXABLE WAGES PAID THIS QUARTER Only the first$7.000 paid to each employee per calendar year is taxable. :...................................................................__...__.__........................................................................_.................._i (--1€ -t i.. ... 1111_.,�.:,--_;,--,�;�.-.., 1 1 11 ... _ �: ,.. ,_1111.,.........., H ii i T ;H1O Mil S ; Iiia ... 12b. 0. 0 CH 0: 0. i E , .,. 1111 t_rrFim,:� A? L ' E X) A. N:iD E 11R ' 12a. 0 0 0 01 _...__,111.1.__F 11 t 11 11 1� lie f f: 1 a:gre i H ) ;:s 1 12b. 0 0 0■ 0 0; r R R Y € . :1i i� 1111. ,,: ? �IR € ii I ";i:a-., 11111 rir<+z:. IE ilk' RA I N i 1;s s' 12b. ll f^ Oi 01■ _1111 ,...,..,.:,- 11--1 __.,......,.,,,.�;111_1..., �._..� -"-' ..�.., ..,_._-_7,---'..--�1_111_.!,.--. E D i :: :; ,s ;: ,11,1,1 �...... i � � :: € ( ....<.. i 1 is [ i € j :::::E .._. is -'�" ^^` :: i :: i ,i i 11 12a I 1......_ ...._........... ,11.11_ ! 1:„:„....1[.........1 :.._...._::..........:._._.._. :......._::.._....._ _.........1:..........::......._.:y.._.._.� ,t._...._.,..--_ _........i 1111..,.. _ _ CV ,111,,1 ,.. :! 1111..; Ltd .._.._......................._ .._........ ......... .._....._.,1111..,. - - __ 1111 li 11 1111...) .�,,=:: c+ i� i I :. ,r- t1111 11 : : :, I: :: 1 ii €1 is i4 t .. •E. is ii :: t [, is .. :., 7 : :: .. irr .. 1111 .z. :. 1111.. �. ,..It, '1 � 12a. i : { k .. ..__.a ..........:i........_...._._......_..................... ....__ .._......1.......: _.... 1.111. __ ,,._....... ..;.,�q+.�, y�� 1111.... ................... 7 �.......... --- .1 i .11-11-- ii .._- midd, kms. .... a..rrc : € 1 a 12b. I.. g ?1 k: I l .: :. •^te .: w e. .. .E :I k. :: 1: :: :. :: i ii it 11 i t..: 1 11 ............. ....k.... , _....._�.._...i..........:._...1.1.1....1,:1.1._.._..1....1..1:..-..-_.........1.1_._._..._,......._.. _i i......_... 11 3`- s `mo �! ■ cef. . _ 1 1 . 1 __ w=;: _ t,. ,€r:e l k Initial i..... 12b. V) ,.._......:€...__.............. ............:................._. ; i r�_:::::'I. - _ E .1 .........:.gt __1.111- -ii..- j ........_:.._....... E i; :: :.. r (. .......:.....__i.._......if............. ...?.... is is e t :: 1 1111........._.._..._..._: .:::::: :::��_:: k ii_-.__,__.__t.-.._ 1 rI?C ; i I 12a. ..._ ..�...... 1.7.,..:::„..11,1„:1. E■ , 1111 j ;i y :��_1_111_�.._s L__ 11>_ _ ._ 1111. ,.. ....;;... 1111 .........1111. ..� 5.. ...i. Middle ...1:e I €1 1 i 1 i 11 1 : I .a i 126. ' t........ ..__E..___L.........1■ 1 ii i iii ................. ......... _1111..:,.._......y _...... .._._.... .._..._.,.__..... - -i"--- ----ii - - - - :; E E: :: :; :_1111 � : .......r 1111... _..._ ...E i 1111.., ..._....;r....... _.,r:::::::. .�I �.'! t' � 1111.,., : i i i,.t1, ii 128. l E i■ _.i i........_i i......_.i i. A L_..._..!..._.....; ��.........;1111...__!i E E......._ ... ...:�......._�. 11;,11: ( il 11 11........:.1111...1 �::::::::•:. Middle r i L.... NiarrieiInitial 12b II.... � i. i _ ._....... ...__... ...._.._..• _...... ........ _.._......_...._.................................................................._..._......_..........._......._..__....._.__..._..............................._...___......................_....,...........,,..........,......._.; r....-.H.-".....H"...."..1 ......._. 11.11.,r....--v 13a. Total Gross Wages(add Lines 12a only). Total this page only. i, 1; l.. .....:k .. : r"....-"If-11.---1 , Include this and totals from additional pages in Line 2 on page 1 I 1 1 5 121'p 0 0 _.. i 1111.: 111.1 P....... i_.._..... L 13b.Total Taxable Wages(add Lines 12b only). Total this page only. 1 Include this and totals from additional pages in Line 4 on page 1. , oI0 : 0 10 01 DO NOT Mail Reply To: Social security numbers(SSNs)are used by the Florida Department of Revenue as unique Reemployment Tax identifiers for the administration of Florida's taxes. SSNs obtained for tax administration Florida Department of Revenue purposes are confidential under sections 213.053 and 119.071,Florida Statutes,and not 5050 W Tennessee St Bldg L subject to disclosure as public records. Collection of your SSN is authorized under state Tallahassee FL 32399-0180 and federal law. Visit our website at www.myilorida.com/dor and select"Privacy Notice" for more information regarding the state and federal law governing the collection,use,or release of SSNs,including authorized exceptions. Please save your instructions! Quarterly Report instructions(RT-6N/RTS-3)are only mailed with new accounts or when there are changes.If you misplace - your instructions,you can download them from www.myflorida.com/dor Visit us at www.53.com 63-9171/670 1010 WALLACE R BOOTH 1835 DOGWOOD DR. MARCO ISLAND,FL 34145 9 ` elute OPa o he ( detr otf ��4r\4JC� ��.: .f r V1-2(J • FIFTH THIRD BANK For1: LO LO