Form Ucs-71 Quarterly Common Paymaster Concurrent Employment Report printable pdf download

Form Ucs-71 Quarterly Common Paymaster Concurrent Employment Report

UCS-71

Quarterly Common Paymaster

R. 08/01

Concurrent Employment Report

UT account number

–

Complete the Quarterly Common Paymaster Concurrent Employment Report (Form UCS-71) and submit with the Employer’s

Quarterly Report (Form UCT-6).

Failure to timely report this information shall result in the related corporations being denied common paymaster

status for that calendar quarter. If a related company has not been assigned an unemployment tax account number, you

must complete and return the Application to Collect and/or Report Tax in Florida (Form DR-1) along with this report.

Total Quarterly Wages for

For quarter/year ending:_________________________

Concurrent Employees

UT Account Number

Name of Related Corporations

Gross

Taxable

–

Pursuant to Chapter 443, Florida Statutes, the undersigned hereby affirms that the information given above is true

and correct and is given for the purpose of determining common paymaster status under said law and is authorized to

execute this report on behalf of the units named.

Name of common paymaster ______________________________________________________________________________________________

Authorized signature ____________________________________________________________________________________________________

Print name ________________________________________________

Phone (______) ___________________________________________

Return address:

FLORIDA DEPARTMENT OF REVENUE

For assistance call:

PO BOX 6510

1-800-482-8293

TALLAHASSEE FL 32314-6510

INTERNET ADDRESS:

Form Ucs-71 Quarterly Common Paymaster Concurrent Employment Report