RT-6A
                                                                                               Florida Department of Revenue                                                                     R. 07/23
                                                                                                                                                                          Rule 73B-10.037,F.A.C. 
                                                                                 Employer’s Quarterly Report Continuation Sheet                                           Effective XX/XX 
                                                                                                                                                                                               Provisional
                                      Employers are required to file quarterly tax/wage reports regardless of employment activity or whether any taxes are due.
Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs 
obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public  RT ACCOUNT NUMBER
records. Collection of your SSN is authorized under state and federal law. Visit floridarevenue.com/privacy for more information regarding the state and 
federal law governing the collection, use, or release of SSNs, including authorized exceptions.
QUARTER ENDING                        EMPLOYER’S NAME                                                                                                    F.E.I. NUMBER

/               //                                                                                                                                       -
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 first $7,000 paid to each employee per calendar year is taxable.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        Middle
                                      Name                                                                         Initial         12b.
                                      Last
  -                 -                 Name                                                                                         12a.
                                      First                                                                        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 of the RT-6.
                                      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 of the RT-6.
E-Verify Certification
I attest, under penalty of perjury, that this employer uses the E-Verify system defined in section 448.095(1)(c), Florida Statutes or the Employment 
Eligibility Verification (Form USCIS I-9), if E-Verify is not available within three business days of a new hire, to verify the employment eligibility of 
newly hired employees.
                                      Signature       _________________________________________________
                                      Title                _________________________________________________
                                      Today’s Date  _________________________________________________