Florida Report to Determine Succession and Application for Transfer of Experience Rating Records R.12/15

Report to Determine Succession and Application for Transfer of Experience Rating Records R.12/15
Form RTS-1S
Report to Determine Succession and Application
for Transfer of Experience Rating Records

RTS-1S
R. 06/21

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
acquired by you.

•	 Determination of succession is also based upon the
amount of time that has elapsed since the previous owners
ceased employing workers in Florida and the new owners
began employing workers.

•	 To be considered an “identifiable and separate” portion of
a business, the portion must be a distinct entity that could
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?

	

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.

Yes

No If no, date closed: _________________________

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:

	

c)	 Lease of business:

	

d)	 Acquire by franchise:

	

e)	 Change in type of business:	 From:	

entire or

part

b)	 Did the former owner operate more than one location in Florida?
entire or
Yes

			

To:	

f)	 Partnership reorganization:

	

g)	 Corporate change:

	

h)	 Legal or insolvency proceedings:	

franchiser

Sole Proprietor

Partnership

Corporation

LLC

Sole Proprietor

Partnership

Corporation

LLC

Merger or consolidation
Foreclosure

Reorganization

Partner

Issuance of new corporate charter

Bankruptcy

Receivership: Ordered by the court
Owner

franchisee or

(Admission or withdrawal of one or more partners)

			
i)	 Death of:

No

part
No If “Yes”, did you acquire from:

	

	

Yes

Yes

No

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.)	

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).	
		

SELECT ONLY ONE

	 No	(Complete number 5(b) OR number 5(c) below, not both.)

	 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_______________
	

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
Florida Department of Revenue
PO Box 6510
Tallahassee FL 32314-6510

850-488-6800
www.floridarevenue.com