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M I N N ESO TA D EPA R TM EN T O F EM PLO YM EN T A N D EC O N O M I C D EVELO PM EN T

U nem pl oym ent I nsurance Em pl oyer A ccounts O ffi ce

390 Robert St . N . - St . Paul , M N

55101

( 612) 296- 3674 - FA X ( 612) 297- 5283

I NSTRUCTI ONS FOR COM PLETI ON OF DEED-874 REPORT

Thi s for m

i s t o be used by em pl oyer s t hat r epor t m or e t han one l ocat i on,

w her e each l ocat i on has been assi gned a separ at e l ocat i on num ber . I t i s t o be

subm i t t ed

w i t h

your D EED -1

and

D EED -1D , and

i s used

t o

r epor t t he

em pl oym ent , w ages and t ax for each i ndi vi dual l ocat i on. The t ot al of al l

l ocat i ons m ust agr ee w i t h t he t ot al s r epor t ed on your D EED -1 and D EED -1D ' s.

Pl ease ent er t he fol l ow i ng i nfor m at i on i n t he spaces pr ovi ded for each l ocat i on:

NUM BER OF EM PLOYEES:

I ncl ude i n t he count any w or ker s ful l or par t -t i m e w ho ar e on your payr ol l

dur i ng t he w eek of t he 12t h of each m ont h. D o t hi s for each m ont h of t he

quar t er for w hi ch you ar e fi l i ng. I ncl ude t hose w or ker s w ho ar e on pai d si ck

l eave, pai d hol i day or pai d vacat i on. Excl ude w or ker s on l eave w i t hout pay.

W or ker s ar e t o be i ncl uded even i f t hey ear ned w ages i n excess of t he

t axabl e w age l i m i t .

TOTAL GROSS W AGES PAI D:

Ent er t he t ot al gr oss w ages pai d and/ or due and payabl e dur i ng t he quar t er .

The t ot al of al l l ocat i ons m ust agr ee w i t h t he am ount on Li ne 4 of t he

D EED -1.

TOTAL NON-TAXABLE W AGES:

Ent er t he t ot al of al l w ages pai d and/ or due and payabl e dur i ng t he quar t er

t hat w er e i n excess of t he t axabl e por t i on as def i ned i n M i nnesot a U nem pl oym ent

I nsur ance l aw . The t ot al of al l l ocat i ons m ust agr ee w i t h t he am ount on Li ne

5 of t he D EED -1.

TAX:

Ent er t he am ount of t ax due for each l ocat i on usi ng t he r at e i ndi cat ed on

t he D EED -874. The t ot al of al l l ocat i ons m ust agr ee w i t h t he am ount on

Li ne 9 of t he D EED -1.

NOTE:

I F THE

PA YM EN T

O N

LI N E 14 I S

D I FFEREN T

FRO M

LI N E 9,

PLEA SE

PRO VI D E

THE

REA SO N

FO R

THE

D I FFEREN CE

( A N D

THE

A FFECTED LO CA TI O N S) O N THE REVERSE O F THE D EED -874.

SPECI AL I NSTRUCTI ONS:

1. I f you sol d or di scont i nued any of t he l ocat i ons l i st ed, pl ease com pl et e

t he Em pl oyer Change Request pr ovi di ng t he effect i ve dat e( s) and t he

nam e( s) of t he pr esent ow ner ( s) , i f sol d.

2. I f you acqui r ed or st ar t ed anot her l ocat i on w hi ch i s not l i st ed, pl ease

at t ach a separ at e sheet show i ng t he effect i ve dat e, t ype of busi ness,

exact addr ess of t hi s l ocat i on and t he nam e of t he pr i or ow ner , i f

pur chased.

D EED -874A ( Rev. 01/ 04)

Instructions For Completion Of Form Deed-874 Report - Minnesta Department Of Employment And Economy Development

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