Form RTS-72 "Affidavit of Concurrent Employment" - Florida

Form form rts-72 is a Florida Department of Revenue form also known as the "Form Rts-72 "affidavit Of Concurrent Employment" - Florida". The latest edition of the form was released in October 1, 2017 and is available for digital filing.

Download an up-to-date Form form rts-72 in PDF-format down below or look it up on the Florida Department of Revenue Forms website.

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Download Form RTS-72 "Affidavit of Concurrent Employment" - Florida

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RTS-72
Affidavit of Concurrent Employment
R. 10/17
TC
Rule 73B-10.037
Florida Administrative Code
Effective Date 10/17
State of
County of
, being duly sworn, does depose and say:
[name of person signing this form (affiant)]
1.
I hold the office indicated for the following common paymaster and related corporation(s) or liability company(ies) LLC
s
(
)
treated as corporations for federal income tax purposes:
Corporate or LLC Name
RT Account Number
Office Held
and I have personal knowledge regarding the facts stated in this affidavit.
2.
I understand that "concurrent employment" means simultaneous employment relationships between an individual, the
common paymaster, and related corporations/LLCs. That those relationships require the performance of services by the
employee for the benefit of the related corporations/LLCs, including the common paymaster, in exchange for wages that, if
deductible for federal income tax, are deductible by the related corporation/LLCs.
3.
That there is "concurrent employment" between the individual, the common paymaster, and the related corporation/LLC(s)
listed below. That the employees perform services for the benefit of the related corporation/LLC(s), including the common
paymaster, in exchange for wages that, if deductible for the purposes of federal income tax, are deductible by the related
corporations/LLCs.
4.
That the name and reemployment tax account number of the common paymaster is:
Name
RT Account Number
5.
That the names and reemployment tax account numbers of the related corporations/LLCs, which are related according to
section (s.) 443.1216(1)(d)3, Florida Statutes (F.S.), are:
RT Account Number
Related Corporation/LLC
(Attach additional sheets, if necessary.)
www.floridarevenue.com
RTS-72
Affidavit of Concurrent Employment
R. 10/17
TC
Rule 73B-10.037
Florida Administrative Code
Effective Date 10/17
State of
County of
, being duly sworn, does depose and say:
[name of person signing this form (affiant)]
1.
I hold the office indicated for the following common paymaster and related corporation(s) or liability company(ies) LLC
s
(
)
treated as corporations for federal income tax purposes:
Corporate or LLC Name
RT Account Number
Office Held
and I have personal knowledge regarding the facts stated in this affidavit.
2.
I understand that "concurrent employment" means simultaneous employment relationships between an individual, the
common paymaster, and related corporations/LLCs. That those relationships require the performance of services by the
employee for the benefit of the related corporations/LLCs, including the common paymaster, in exchange for wages that, if
deductible for federal income tax, are deductible by the related corporation/LLCs.
3.
That there is "concurrent employment" between the individual, the common paymaster, and the related corporation/LLC(s)
listed below. That the employees perform services for the benefit of the related corporation/LLC(s), including the common
paymaster, in exchange for wages that, if deductible for the purposes of federal income tax, are deductible by the related
corporations/LLCs.
4.
That the name and reemployment tax account number of the common paymaster is:
Name
RT Account Number
5.
That the names and reemployment tax account numbers of the related corporations/LLCs, which are related according to
section (s.) 443.1216(1)(d)3, Florida Statutes (F.S.), are:
RT Account Number
Related Corporation/LLC
(Attach additional sheets, if necessary.)
www.floridarevenue.com
RTS-72
R. 10/17
Page 2
6.
The following is a list of employees who are engaged in concurrent employment, their social security numbers, the quarter
and year they were first engaged in concurrent employment, the name of the corporation/LLCs for which their services
are performed (other than the common paymaster), the corporation/LLCs' reemployment tax account numbers, and the
physical locations where the services are performed:
Name of Employee
Name of Corporation/LLC
Quarter/Year
RT Account Numbers
Physical Locations Where
Social Security Number*
Other than Common Paymaster
Reported Under
the Services are Performed
First Engaged
7.
That I understand s. 443.071(2), F.S., states that "Any employing unit or any officer or agent of any employing unit or any
other person who makes a false statement or representation, knowing it to be false, or who knowingly fails to disclose
a material fact, to prevent or reduce the payment of benefits to any individual entitled to benefits, to avoid becoming
or remaining subject to this chapter, or to avoid or reduce any contribution, reimbursement, or other payment required
from an employing unit under this chapter commits a felony of the third degree, punishable as provided in s. 775.082,
s. 775.083, or s. 775.084, F.S."
(signature of affiant)
Sworn to and subscribed before me this _____ day of _____________ by _____________________, who is personally
known to me or has produced ________________________________ as identification.
NOTARY PUBLIC Commission Number ___________________
*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, F.S.,
and not subject to disclosure as public records. Collection of your SSN is authorized under state and federal law. Visit our
Internet site at www.floridarevenue.com and select "Privacy Notice" for more information regarding the state and federal
law governing the collection, use, or release of SSNs, including authorized exceptions.
(Attach additional sheets, if necessary.)
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