Form Rts-10 - Agent/client Change Form

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RTS-10
R. 01/13
Rule 73B-10.037
Florida Administrative Code
Florida Department of Revenue
Reemployment Tax*
Agent/Client Change Form
Agent Name:
Contact:
Mailing Address:
Title:
Agent Number (5 digits):
Phone:
FEIN:
Fax:
Use this form to add or delete clients for the purpose of filing or paying reemployment tax.
ADD
DELETE
Client Name and Mailing Address
RT
FEIN
*Effective
**Effective
Account No.
Begin Date
End 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).
**Effective End Date is the last day of the reporting period for which you represent the client (i.e., 3/31/07, 6/30/07, 9/30/07, 12/31/07).
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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