Rts-9, 2013, Application For Agent Registration

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RTS-9
R. 01/13
TC
Rule 73B-10.037
Florida Administrative Code
Florida Department of Revenue
Effective Date 11/14
Reemployment Tax*
DOR Use Only:
Application for Agent Registration
____________________
Agent Number
Agent Name:
Contact:
Mailing Address:
Title:
RT Account Number (if applicable):
Phone:
FEIN:
Fax:
Registering as an agent allows you to file and/or pay on behalf of the clients listed. For the Department to
disclose confidential tax information, a Power of Attorney (DR-835) must be submitted for each client. You will
not be allowed to register as an agent unless you represent at least one client.
Client Name and Mailing Address
RT
FEIN
*Effective
Account No.
Begin Date
*Effective Begin Date is the date you begin representing your client. This date must be the beginning of a reporting period
(i.e., 1/1/07, 4/1/07, 7/1/07, 10/1/07).
Signature of Agent:
Date:
Mail to:
Account Management
For more information call
Florida Department of Revenue
800-352-3671.
PO Box 6510
Tallahassee, FL 32314-6510
* Formerly Unemployment Tax

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