Form Ui111 - Mtq - Montana Employer'S Quarterly Tax Report - Unemployment Insurance Only

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Quarter End
Due Date
MTQ – Montana Employer’s Quarterly
Tax Report – Unemployment Insurance Only (UI111)
Customer Id
Federal Id (FEIN)
UI Contribution Rate
%
UI Administrative Fund Tax Rate
%
UI Total Tax Rate
%
UI Annual Taxable Wage Base $
(Each Employee)
A report must be filed to avoid penalties. Please refer to MTQ instructions for information on completing this form.
Step 1. Check box(es), if applicable, and provide information requested.
No wages paid for the quarter covering this report
Sold business - name and address of new owner:
Ceased employing - last payroll date ____/_____/____
Change in name, address, telephone number and/or identification number (list corrections here):
Amended report
Step 2. Unemployment Insurance Employees’ Wage Listing
Note: Mail your electronic file along with completed coupon and payment.
If you file taxes and wages electonically,completethe UI side with N/A.
.
If you are an electronic wage filer only, complete per instructions
Step 3. Calculate Tax
State Unemployment Insurance (UI)
1.
Total wages paid this quarter ………………………………………
1a
2.
UI excess wages (except governmentals and reimbursables)….
2a
3.
UI taxable wages (box 1a minus box 2a)………………………….
3a
4.
UI total tax rate……………………………………………………….
4a
5.
Total tax (box 3a times box 4a)……………………………………
5a
6.
Credits (minus overpayment from prior quarters) …………….…
6a
Line 7 does not apply to this form
8.
Adjustments to prior quarters (attach explanation) …………...…
8a
9.
Balance due ………………….……………………………….……
9a
10.
Penalty and interest, if you file late ……………………..…………
10a
11.
Subtotal (boxes 9a + 10a)…………………….……………….……
11a
12.
Total payment enclosed. Payment should equal
the amount from box 11a……………………………………….
12
Step 4. Number of UI Employees
th
Number of covered workers who worked during or received pay for the payroll, which includes the 12
day of the month.
st
nd
rd
1
Month________________________ 2
Month__________________________ 3
Month______________________
Step 5. Summary of WH Tax Liability for Monthly Withholding Payers Only. Total WH Liability should equal line 5b.
*** DOES NOT APPLY TO THIS FORM***
Step 6. Payment Coupon.
Complete the coupon by entering the amounts from 11a and 12 from Step 3 above onto the
coupon below. Return payment and coupon with form MTQ and UI-5A. Do not fold or staple the coupon. Mail your MTQ and
applicable forms along with payment to the Department of Revenue by the due date above, even if no tax is due. Question?
Call (406) 444-6900
Step 7. Sign and make a
I certify the information on this report and
Date:
copy of this form for your
attachments are true and correct.
records. Mail to:
Department of Revenue
Authorized Signature/Title
Telephone No.
Name/Title of Contact Person
Telephone
PO Box 6339
No.
Helena, MT 59604-6339
Mail this entire form with your check to the Montana Department of Revenue
Make checks payable to the Montana Department of Revenue
MTQ Quarterly Coupon
Quarter Ending Date:
Please use black or blue ink only when filling out coupon
.
Customer Id:
FEIN:
,
,
.
11a UI
,
,
.
11b WH
Department of Revenue
Do not staple
PO Box 6339
your check or
,
,
.
correspondence
Helena MT 59604-6339
12 Total
to this coupon.
2210101XXXX5851135101010000004000000000000

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