Form Dr-1 - Florida Business Tax Application (Page 6 of 10) in pdf

DR-1

R. 01/18

Page 6

If yes, provide the date you reached or will reach $10,000 gross wages: ......................................................

Have you or will you employ five or more workers for 20 or more weeks within a calendar year? ** ................................................................

If yes, provide the date of the 20th week: ......................................................................................................

34. Have you paid federal unemployment tax in another state this year or last year? ..............................................................................................................

If yes, in which state: ________________________________________ in which year: .....................................................................................

35. Do you use the services of persons in Florida whom you consider to be self-employed, independent contractors? .........................................................

If yes, also complete an Independent Contractor Analysis (RTS-6061)

36. Do you lease workers from an employee leasing company? ..............................................................................................................................................

If yes, complete items a–f about the leasing company and your leasing arrangement.

a. Leasing company’s name:

b. FEIN:

c. DBPR License Number:

d. RT Account Number:

e. Portion of workforce that is leased:

All

Part

f. Date of leasing arrangement:

37. List the locations where you employ workers in Florida.

Address:

City:

County:

Number of employees:

Principal products or services:

If services, indicate if

Administrative

Research

Other: ________________________________________

Address:

City:

County:

Number of employees:

Principal products or services:

If services, indicate if

Administrative

Research

Other: ________________________________________

Address:

City:

County:

Number of employees:

Principal products or services:

If services, indicate if

Administrative

Research

Other: ________________________________________

38. If another party (accountant, bookkeeper, agent) will maintain your payroll, provide the following information about the other party:

Individual or firm name:

Federal ID number (FEIN, PTIN):

Mailing address:

City/State/ZIP:

( )

Email address:

Telephone number:

39. Mailing addresses for reemployment tax – All correspondence about your reemployment tax account, returns, statements, rate notices, and claims and benefits

information, will be mailed to the address you provided in item 6. If you wish to have these documents mailed elsewhere, provide other addresses below.

Reporting – Mail Employer’s Quarterly Reports, certifications, and

correspondence related to reporting to (check one):

Payroll address (item 38)

Other, below

( )

Name:

Telephone number:

Mailing address:

City/State/ZIP:

Email address:

Tax Rate – Mail tax rate notices and rate-related correspondence to

(check one):