RTS-1S
R. 12/15
Page 2
4. Date of acquisition __________/__________/__________. Did you acquire all of the business?
Yes (Complete number 5(a) OR number 5(c) below, not both.)
No (Complete number 5(b) OR number 5(c) below, not both.)
5(a).
Total Succession (You have acquired 100% of the business and the predecessor has ceased payroll in Florida.)
In consideration of the transfer, the successor will be responsible for any indebtedness that is past due with respect to
wages paid by the predecessor prior to the date of succession. Any reemployment assistance benefits paid to former
employees of the predecessor will be charged to the successor employer and will be used in future tax rate calculations.
The successor employer does hereby request a transfer of the employment records from the account of the
predecessor employer. Upon receipt of a timely Form RTS-1S, the Department will compute your rate and notify you
by mail. You will then have 20 days to withdraw the application if you do not want the rate.
Successor signature: ___________________________________________________________ Date: _________________
Print name: _________________________________________ Title: ____________________________________________
5(b).
Partial Succession (You have acquired less than 100% of a business and the portion you acquired is an
identifiable and separate portion of the business you acquired.)
This portion of the form must be accompanied by the List of Employees to be Transferred (RTS-1SA, formerly
UCS-1SA) if you are transferring up to ten employees. If you are transferring more than ten employees, you must
send a list of employees to the Department electronically. For information on how to access the online system,
please call 850-488-6800.
The successor employer is liable for benefit charges paid to transferred employees for any claim based on wages
paid by the predecessor up to the date of succession.
The successor employer does hereby request a transfer of the employment records from the predecessor employer.
Upon receipt of a timely Form RTS-1S and Form RTS-1SA, the Department will compute your rate and notify you by
mail. You will then have 20 days to withdraw the application if you do not want the rate.
Successor signature: ___________________________________________________________ Date: _________________
Print name: _________________________________________ Title: ____________________________________________
To be completed by the predecessor employer:
You must provide the date the employing unit being transferred first employed workers. This is not the
acquisition date, but is the date the unit was first reported by the predecessor(s): Date ______________
The predecessor employer hereby agrees to furnish such employment records pertaining to employment in
that portion of the business acquired by the successor employer and certifies that the form attached to the
application represents only employment in the portion of the business during the periods covered by the
forms. I understand that my future tax rate may be affected.
Predecessor signature: __________________________________________________________ Date: _________________
Print name: _________________________________________ Title: ____________________________________________
5(c).
Rejection of Transfer
The successor employer does hereby refuse a transfer of the employment records from the account of the
predecessor employer.
Successor signature: ___________________________________________________________ Date: _________________
Print name: _________________________________________ Title: ____________________________________________
Mail completed form to:
850-488-6800
Account Management
Florida Department of Revenue
PO Box 6510
Tallahassee FL 32314-6510