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In order to comply with State of Florida requirements related to workers' compensation coverage, please  complete this brief payroll report.  Please review your payroll records (941's etc) for the calendar year 2015 and complete the form as accurately as possible.  Your responses will not affect your workers' compensation insurance costs for 2016 as this updated information is simply required to comply with State of Florida regulations.
The deadline for this information is February 23, 2016.

Please note: You can now leave and return to this form as many times as needed. You can also print each page by right clicking and selecting the print option.

Thank you

* 1. Church Name

* 2. GCFA Number

* 3. Street Address

* 4. City

* 5. State

* 6. Zip

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