Form Rts-72 - Affidavit Of Concurrent Employment

Form Rts-72 - Affidavit Of Concurrent Employment - 2013

RTS-72

Affidavit of Concurrent Employment

R. 01/13

Rule 73B-10.037

Florida Administrative Code

STATE OF ___________________________________

COUNTY OF ________________________________

__________________________________________________, BEING DULY SWORN, DOES DEPOSE AND SAY:

[name of person signing this form (affiant)]

I hold the office indicated for the following common paymaster and related corporation(s) or liability company(ies)

LLC

treated as corporations for federal income tax purposes:

(

)

Corporate or LLC Name

RT Account No.

Office Held

and I have personal knowledge regarding the facts stated in this affidavit.

I understand that “concurrent employment” means simultaneous employment relationships between an individual,

the common paymaster, and related corporations/LLCs. That those relationships require the performance of services

by the employee for the benefit of the related corporations/LLCs, including the common paymaster, in exchange for

wages that, if deductible for federal income tax, are deductible by the related corporation/LLCs.

That there is “concurrent employment” between the individual, the common paymaster, and the related corporation/

LLC(s) listed below. That the employees perform services for the benefit of the related corporation/LLC(s), including the

common paymaster, in exchange for wages that, if deductible for the purposes of federal income tax, are deductible

by the related corporations/LLCs.

That the name and reemployment tax account number of the common paymaster is:

______________________________________________________

___________________________________________.

Name

RT Account Number

That the names and reemployment tax account numbers of the related corporations/LLCs, which are related according

to section 443.1216(1)(d)3, Florida Statutes (F.S.) are:

Related Corporation/LLC

RT Account No.

(Attach additional sheets, if necessary.)

Form Rts-72 - Affidavit Of Concurrent Employment - 2013