Free UCT-8A - Florida

Correction to Employer's Quarterly or Annual Domestic Report
Do Not Use This Area UT Account Number FEI Number Employer's Name Street Address City State ZIP Correction to Reporting Period Ending Batch Number Audited By Date Remarks

Florida Department of Revenue

UCT-8A R. 07/07 Page 1

Explain, in detail, the reason for correction
1. Employee's Social Security Number 2.
Last

Employee's Name
First Middle Initial Initial

3. Page No.

4.

Gross Wages Per Original Report

5.

Unit Code

6.

Correct Gross Wages

7. Unit Code

8. If this information changes the figures on your original report please complete the section below. Originally To Be Item Reported Corrected To Difference
Gross Wages Excess Wages Taxable Wages

Totals This Page

$ $

$

Difference Between Column 4 and 6

I certify that the information contained in this report is true and correct. Signature Title Make check payable to Florida U.C. Fund Phone No. Date $

Tax Due

See page 3 for complete instructions and coupon

Th is pa ge in te nt io na lly le ft

bl an k.
UCT-8A R. 07/07 Page 2

Correction to Employer's Quarterly or Annual Domestic Report Instructions
This form (Form UCT-8A) is provided for use in correcting errors made on the original Employer's Quarterly Report (Form UCT-6) or Annual Report for Employers of Domestic Employees Only (UCT-7). Annual filers will need to complete one UCT-8A for each quarter being corrected. Items 1 and 2 are used to correct an employee's name or social security number. Caution: Be sure that the employee's social security number and name shown in Items 1 and 2 agree with your original report, unless the social security number and name originally reported were incorrect. In such a case, enter the number and name, as per the original report. Underneath, write social security number change and/or name change; then list the correct social security number and/or name. Item 3 should be completed if continuation sheets were filed with the original report. Items 4 and 6 are used to correct gross wages. Items 5 and 7 should be omitted unless you have received prior approval. Unit codes are special codes assigned employers to identify the mailing address for unemployment insurance claims forms, if different from the primary employer address. Complete Item 8 if individual wage corrections change gross wages, excess wages, or taxable wages originally shown on the tax report. Coupon Completion Instructions

UCT-8A R. 07/07 Page 3

Write your seven digit account number and the check digit in the "Account No." boxes provided. Enter the federal employer's identification number in the "F.E.I. Number" boxes. Enter the employer's legal entity name and the mailing address in the space provided. Enter the amount of payment in the "Amount Enclosed" boxes. Enter the 1 digit quarter and 2 digit year in the boxes labeled "Payment for QTR/YR." For the quarter box, enter the number "1" for quarter ending March 31st, the number "2" for quarter ending June 30th, "3" for quarter ending September 30th and "4" for quarter ending December 31st. In the year boxes, enter the last two digits for the year. For example: enter "07" for 2007. Mail the original completed form and coupon along with any remittance due to: Florida Department of Revenue 5050 W Tennessee Street Tallahassee FL 32399-0180 Need Assistance? To speak with a Department of Revenue representative, call Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m., ET, at 800-482-8293. Hearing or speech impaired persons may call the TDD line at 800-367-8331 or 850-922-1115.

Complete page 1 for corrections to the Employer's Quarterly or Annual Domestic Report. Complete page 3 only if payment is enclosed. Return completed form and coupon, if applicable, to the Department. DO NOT DETACh
UCT-8A R. 07/07

IMPORTANT

Correction to Employer's Quarterly or Annual Domestic Report Payment Coupon
Florida Department of Revenue COMPLETE and MAIL with your REPORT/PAYMENT. Please write ACCOUNT NUMBER on your check. Be sure to SIGN YOUR CHECK. Make check payable to: Florida U.C. Fund DOR USE ONLy

POSTMARk OR hAND DELIvERy DATE

ACCOUNT NO. F.E.I. NUMBER



AMOUNT ENCLOSED

US Dollars

Cents

,


,

PAyMENT FOR QTR/yR
Name Address City/St/ZIP

UCT-8A

Check here if you transmitted funds electronically.

9100 0 99999999 0068054049 2 5009999999 0000 4