Form RTS-10 Fillable Reemployment Tax Agent/Client Change Form R.01/13
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Florida Department of Revenue 800 352 3671 PO Box 6510 Tallahassee FL 32314 6510 (Attach additional sheets if necessary ) (i e 1/1/07 4/1/07 7/1/07 10/1/07) * Formerly Unemployment Tax **Effective **Effective End Date is the last day of the reporting period for which you represent the client (i e 3/31/07 6/30/07 9/30/07 12/31/07) *Effective *Effective Begin Date is the date you begin representing your client This date must be the beginning of a reporting period Account No Agent Name: Agent Number (5 digits): Agent/Client Change Form Begin Date Client Name and Mailing Address Contact: Date: DELETE Effective Date 11/14 End Date FEIN: Florida Administrative Code Florida Department of Revenue Mail to: Account Management For more information call Mailing Address: Page 2 Phone: R 01/13 Reemployment Tax* RTS 10 Rule 73B 10 037 Signature of Agent: Title: Use this form to add or delete clients for the purpose of filing or paying reemployment tax www myflorida com/dor