Form Rts-8 - Firm'S Statement Of Claimant'S Work And Earnings
ADVERTISEMENT
1RTS-8
Firm’s Statement of Claimant’s Work and Earnings
R. 01/13
TC
Please Complete and Return Immediately
Rule 73B-10.037
Florida Administrative Code
Effective Date 11/14
If you do not reply within five (5) days of the receipt of this form, the claimant’s certification of wages will be used to determine
eligibility and your account made liable for taxes on such wages.
1.
Firm’s Legal Name and Address:
2. R.T. Account No.:
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 records. Collection of your SSN is authorized under
_____________________________________________________________
state and federal law. Visit our Internet site at
and select “Privacy Notice” for more information regarding the state and
_____________________________________________________________
federal law governing the collection, use, or release of SSNs, including
authorized exceptions.
—
—
3.
Claimant’s Name: ____________________________________________________
4. SSN:
5.
Nature of work performed: __________________________________________________________________________________________________________
6.
The above claimant has applied for benefits under the Florida reemployment assistance law (formerly unemployment compensation) and has
named you as the employer during the time listed below:
M M D D
Y
Y
M M D D
Y
Y
The claimant states that work was performed from
to
M M D D
Y
Y
M M D D
Y
Y
7.
What are the dates the worker performed services for you? Began
Ended
8.
Are the claimant’s name and social security number exactly as shown on your records?
Yes
No
If not, please provide name and/or SSN
Name: _______________________________________________________________________________________
—
—
SSN:
9.
Please list GROSS AMOUNTS actually paid to the claimant in each quarter in Florida:
QUARTER ENDING
YEAR
GROSS AMOUNT PAID
March 31
$
June 30
$
September 30
$
December 31
$
10. Was the claimant considered an independent contractor?
Yes (Complete the Independent Contractor Analysis (Form RTS-6061))
No (Item #11 must be completed)
11. Claimant _________________________________________________________________________________________________________was an employee.
Name
This certifies that the above wages were earned in covered employment and acknowledges liability for tax on such wages,
unless otherwise indicated in item 10 above.
Signed __________________________________________________________ Title _______________________________________ Date __________________
FIRM’S REMARKS (You may attach another page if more space is needed):
Please indicate that an additional page is attached.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial