Report to Determine Succession and Application                                                   RTS-1S 
                                                                                                                            R. 06/21
                              for Transfer of Experience Rating Records                                          Rule 73B-10.037, F.A.C.
                                                                                                                            Effective 06/21

If you acquire an existing business, in whole or in part, you are required, within 90 days of the date of the acquisition, to 
complete this form, unless there was any common ownership, management or control between the businesses. If there was 
common ownership, management or control, you only need to advise the Department in writing of the acquisition within 
90 days. (The Department recommends using this form to advise the Department.) You are required to complete a Florida 
Business Tax Application (DR-1) if you change the nature of your business entity (e.g., from a partnership to a corporation, 
from a corporation to a proprietorship, etc.).
Listed below are factors used to determine if a succession occurred, for example:
•  The percentage of the existing business entity that was         •  Determination of succession is also based upon the 
  acquired by you.                                                 amount of time that has elapsed since the previous owners 
•  To be considered an “identifiable and separate” portion of      ceased employing workers in Florida and the new owners 
  a business, the portion must be a distinct entity that could     began employing workers.
  operate independently from the remainder of the business.

 1.  Previous owner information: 
  Legal name:  _________________________________________________________________________________________________
  Trade name (D/B/A):  __________________________________________________________________________________________
  Address:  ____________________________________________________________________________________________________
  RT Account No.: ____________________________ FEIN: ______________________ Telephone: ___________________________

  Was the business being operated at the time of acquisition?       Yes   No  If no, date closed:  ________________________
  What is the principal product or service of the business?  __________________________________________________________
  If the business was an employee leasing company, please attach a list of its client companies.

 2.  Current owner name:
  Legal name:  _________________________________________________________________________________________________
  Trade name (D/B/A):  __________________________________________________________________________________________
  Address:  ____________________________________________________________________________________________________
   _____________________________________________________________________________________________________________
  RT Account No.: ____________________________ FEIN: ______________________ Telephone: ___________________________
  What is the principal product or services of the business?  _________________________________________________________
  Was there any common ownership, management, or control between the two entities at the time the

  purchase/change occurred?  Yes         No 

 3.  What is the nature of the acquisition or change of business entity?
  a)  Purchase of business:      entire or       part
  b) Did the former owner operate more than one location in Florida?        Yes            No
  c)  Lease of business:        entire or        part
  d) Acquire by franchise:       Yes             No   If “Yes”, did you acquire from:      franchisee or      franchiser
  e)  Change in type of business:  From:         Sole Proprietor      Partnership          Corporation        LLC
                                   To:           Sole Proprietor      Partnership          Corporation        LLC
  f)  Partnership reorganization:     (Admission or withdrawal of one or more partners)
  g) Corporate change:          Merger or consolidation           Reorganization           Issuance of new corporate charter
  h)  Legal or insolvency proceedings:           Foreclosure      Bankruptcy
                                                 Receivership: Ordered by the court        Yes       No
  i)  Death of:       Owner      Partner

                                                                                                                                      RTS-1S 
                                                                                                                                      R. 06/21
                                                                                                                                      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) 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 ______________
 SELECT ONLY ONE       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:
                       Account Management                                              850-488-6800
                       Florida Department of Revenue                                   www.floridarevenue.com
                       PO Box 6510
                       Tallahassee FL 32314-6510