Florida Voluntary Election to Become an Employer Under the Florida Reemployment Tax Law R.01/13

Voluntary Election to Become an Employer Under the Florida Reemployment Tax Law R.01/13
Form RTS-2
RTS-2
R. 01/13
TC

Voluntary Election to Become an Employer
Under the Florida Reemployment Tax* Law
Complete this form only if you do not meet the liability criteria

Owner name:
	

Rule 73B-10.037
Florida Administrative Code
Effective Date 11/14

(Legal name of individual, principal partner, or corporation)

Mailing address:
	

City	 State	ZIP

The above named, being an employing unit under the Florida reemployment tax law, to the same
extent as any other employer liable to pay contributions thereunder, does hereby voluntarily elect, according to
the terms and provisions of Section 443.121(3), Florida Statutes (F.S.), thereof, to become, as of
	 (a)	

first day of January, 20

	 (b)	

date stated in firm’s request 	

	

–

–

Month	Day	 Year

an employer liable to pay contributions under the Florida reemployment tax law, to the same extent as any other
employer, and hereby makes application for the written approval of such election by the Department.
The undersigned agrees to be governed by all the terms, conditions and provisions of the Florida reemployment
tax law and the rules and regulations of the Florida Department of Revenue to pay the contributions required of employers
by said law.
The undersigned attaches hereto fully executed DR-1.
Date:	

–

–

	 Month	Day	 Year

Owner name:__________________________________________________________
(Legal name of individual, principal partner, or corporation.)

	By:___________________________________________________________________
	Title:_________________________________________________________________
	

Phone number: (________)______________________________________________

* Formerly Unemployment Tax
FOR DEPARTMENTAL USE
Approved
	
Date:	
–

Denied	

By:_________________________________________________
State of Florida
Department of Revenue

–

	 Month	Day	 Year

Effective date of liability:
–

–

	 Month	Day	 Year

Return address:	
	
	

Florida Department of Revenue	
PO Box 6510	
Tallahassee FL 32314-6510
www.floridarevenue.com

For assistance call:
850-488-6800