Employer Account Change Form
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).
RTS-3
R. 10/17
TC
Rule 73B-10.037
Florida Administrative Code
Effective Date 10/17
Account Name
(name of business or individual):
RT Account Number:
Mailing Address: Business Partner Number:
City/State/ZIP: Tax Certificate Number:
Email Address: Federal Identification Number:
Telephone Number: Extension: Fax Number:
Section 1: Identify your tax account. To ensure changes are made to the correct account, please complete the
following information.
Section 3: Change your address. Select the address type and provide the new address information.
Address Type:
(choose one or more)
Corporate Income Tax
Motor Fuels Tax
Gross Receipts Tax
Documentary Stamp Tax
Communications Services Tax
Solid Waste Fees and Surcharge
Sales and Use Tax
Business Location Address
Mailing Address
RT Benefit/Claims Notice
Employer's Quarterly Report
RT Tax Rate Notice
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.
Effective date:
Corporate name changed to:
Section 6: Leasing Employees. I am leasing all or part of my employees.
Leasing all of my employees
Leasing part of my employees
Date I began leasing employees:
Leasing Company's RT Account Number:
Leasing Company's Federal Identification Account Number:
Leasing Company's DBPR License Number:
Section 7: Sign and date
Date:
Telephone Number:Title:
Signature:
I certify that I am legally authorized to make these changes with respect to the account number shown above.
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 850-488-6800 for assistance.
Information and forms are available on our website at:
floridarevenue.com
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.
E-911 Tax
