Form Uch-1 - Payment Voucher For Unclaimed Property Holder Report
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1CLEAR FORM
Payment Voucher for
Unclaimed Property Holder Report
(UCH-1)
Payment Instructions
Complete the payment voucher below to ensure proper credit of your payment. If you are remitting unclaimed property for
multiple report periods, submit a separate check or money order and a separate voucher for each report period. On the
memo line of your check, please note your FEIN or account ID and the report period for which the payment applies.
Box 1 – Enter the report period for which this payment applies.
Box 2 – Enter your federal employer identification number (FEIN).
Box 3 – Enter the amount you are remitting. (This amount should be the same as reported in Section I of your report.)
Holder Information:
Name __________________________________________________________________
Address _______________________________________________________________
_______________________________________________________________
City, State, Zip Code ______________________________________________________
Phone ____________________________
Contact Information:
Name _________________________________________________________________________________________
Phone Number ______________________________________ Email Address ______________________________
Mail this form with your payment (and your report, if you did not e-file) to:
Department of Revenue
PO Box 5805
Helena, MT 59604-5805
Questions? Call us toll-free 1-866-859-2254 (in Helena, 444-6900).
Make check or money order payable to the Department of Revenue.
Unclaimed Property Holder Report
Payment Form
Month
Day
Year
2. Federal Employer
Identification
1. Report Period Ending
/
/
Number (FEIN)
3. Amount Paid
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