Form Ucm-1 - Multiple Holder Payment Voucher - Payment Voucher For Trust For Unlocatable Mineral Owners

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CLEAR FORM
Payment Voucher for Trust for Unlocatable Mineral Owners
(UCM-1 – Multiple Holder Payment Voucher)
Payment Distribution Detail. Enter information as it appears on holder report.
Holder FEIN
Holder Name
Amount
Period End Date
Total Amount Remitted:
q
These reports were submitted electronically. Date Submitted _______________________________________
Important: If you sent reports electronically, mail only this form with your payment--please do not attach any other
documentation.
Contact Name ____________________________________________________________________________________
Phone Number ______________________________________ Email Address ________________________________
Mail this form with your payment (and report, if you did not submit it electronically) to:
Montana Department of Revenue
PO Box 5805
Helena, MT 59604-5805
Make check or money order payable to the Department of Revenue.
Questions? Call us toll-free 1-866-859-2254 (in Helena, 444-6900).

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