Employer Account Change Form
RTS-3
R. 01/13
Rule 73B-10.037
Florida Administrative Code
Section 1: Identify your tax account. To ensure changes are made to the correct account, please complete the
following information.
Account Name
(name of business or individual): RT Account Number:
Mailing Address: Business Partner Number:
City/State/ZIP: Tax Certicate Number:
Email Address: Federal Identication Number:
Telephone Number: ( ) Extension: Fax Number: ( )
Section 2: Tax Type. This change applies to reemployment tax “RT” (formerly unemployment tax). However, if you wish to apply
this change to your other tax accounts, please check the applicable boxes below.
❏ Corporate Income Tax ❏ Gross Receipts Tax ❏ Communications Services Tax ❏ Sales and Use Tax
❏ Motor Fuels Tax ❏ Documentary Stamp Tax ❏ Solid Waste Fees and Surcharge
Section 3: Change your address. Select the address type and provide the new address information.
Address Type:
(choose one or more)
❏ Business Location Address ❏ RT Benet/Claims Notice ❏ RT Tax Rate Notice
❏ Mailing Address ❏ Employer’s Quarterly Report
New Address Information
(name of business or individual):
Mailing Address:
City/State/ZIP: Fax Number: ( )
Email Address: Telephone Number: ( ) Extension:
Section 4: Change your account status. Request to inactivate, reactivate or cancel your account. Check the box next to the
appropriate action and provide the date this action becomes effective.
Action Requested (choose only one):
❏ Inactivate – I have temporarily suspended business operations; I have no employees
❏ Reactivate – My business is now active; I am again paying wages
❏ Cancel – I have no plans for future business activity; cancellations can not be reversed
Effective date of action:
Section 5 : Corporate name change. I have changed my corporate name.
Corporate name changed to: Effective date:
Section 6: Leasing Employees. I am leasing all or part of my employees.
❏ Leasing all of my employees
Leasing Company’s
RT Account Number:
❏ Leasing part of my employees
Leasing Company’s
Federal Identication Number:
Date I began leasing employees: Leasing Company’s DBPR license number:
Section 7: Sign and date
I certify that I am legally authorized to make these changes with respect to the account number shown above.
Signature: Date:
Title: Telephone Number: ( )
Sign, date, and mail this Employer Account Change Form to:
Florida Department of Revenue
P.O. Box 6510
Tallahassee FL 32314-6510
or fax to:
850-245-5896
Call 800-352-3671 for assistance.
Information and forms are available on our Internet site at:
www.myorida.com/dor
If you need to report a change in legal entity or a change in ownership, you must submit a new
Florida Business Tax Application (DR-1).
uidocs@adpunemploymentclaims.com
