Company ID Here
                                                                                         Employer’s Quarterly Report                                                                                                          RT-6NF 
                                                                                                                                                                                                                          R. 07/23 
                                                                                         for Out-of-State Taxable Wages                                                                                    Rule 73B-10.037, F.A.C. 
                                                                                                                                                                                                               Effective XX/XX
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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 andwww.floridarevenue.comfederal law. Visit ourandwebsiteselectat“Privacy Notice” for more information  t regarding          the sateand 
federal  law        governing  the  collection,    use,   or release of  SSNs, including authorized exceptions. 

                                                                               EMPLOYER’S Name: FDOR – Employer Test

 1234567                 012345678                                     0318 

 123456789               LAST        NAME                              FIRST NAME & MI              01234567890        01234567890                                                 01234567890 

   123456789             LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

 123456789               LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

   123456789             LAST        NAME                                FIRST NAME & MI            0123456789  0      01234567890                                                 01234567890 

 123456789               LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

123456789                LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

 123456789               LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

123456789                LAST NAME                                       FIRST NAME & MI            01234567890        01234567890                                                 01234567890 

                                                                                                    01234567890        01234567890                                                 01234567890 

                                                                                                    01234567890        01234567890                                                 01234567890 

E-Verify Certification
I attest, under penalty of perjury, that this employer uses the E-Verify system defined in section 448.095(1)(c), Florida Statutes or the Employment 
Eligibility Verification (Form USCIS I-9), if E-Verify is not available within three business days of a new hire, to verify the employment eligibility of 
newly hired employees.
                                      Signature       _________________________________________________
                                      Title                _________________________________________________
                                      Today’s Date  _________________________________________________