Form Rts-5 - Application To Terminate Reemployment Tax Account

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RTS-5
Application to Terminate
R. 01/13
Reemployment Tax* Account
Rule 73B-10.037
Florida Administrative Code
Your application must be received by April 30 of the year for which termination is requested.
Legal Entity
Reemployment Tax account number
Mailing Address
City, State, ZIP
As an employer under the Florida reemployment assistance program law, we hereby make formal
application to cease to be an employer in accordance with the provision of said law as of the first day
of January, 20
.
Please check appropriate box below:
For Domestic Employment
❑
Did not pay cash of $1,000 or more in any calendar quarter in either the current or
preceding calendar year.
For Regular Employment
❑
Did not pay wages of $1,500 or more in any calendar quarter in either the current or
preceding calendar year.
❑
Did not have at least one employee for any portion of a day in 20 different calendar
weeks in either the current or preceding calendar year.
For Agricultural Employment
❑
Did not pay wages of $10,000 or more for agricultural service in any calendar quarter in
either the current or preceding calendar year.
❑
Did not have at least five employees for any portion of a day in 20 different calendar
weeks in either the current or preceding calendar year.
For Non-Profit Organizations
❑
Did not have at least four or more employees for any portion of a day in each of 20
different weeks in either the current or preceding calendar year.
I understand that if my reemployment tax account is terminated and I subsequently have
employment sufficient to reestablish liability for reemployment tax, I will be treated as a new
employer for the purpose of establishing a reemployment tax rate.
Signature
Date
(
)
Title
Telephone Number
For Department of Revenue use only
Mail completed form to:
Florida Department of Revenue
❑
❑
Approved
Denied
Account Management
PO Box 6510
Date _____________________________
Tallahassee,FL 32314–6510
By ______________________________
* Formerly Unemployment Tax

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