Form Mdes-874 - Quarterly Tax Report Location Breakdown - 2003
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1MINNESOTA DEPARTMENT OF ECONOMIC SECURITY
Unemployment Insurance Tax Office
390 North Robert - St. Paul, MN 55101-1812
(651) 296-3674 - Fax (651) 297-5283 - TTY/TDD Dial 711
Internet: - e-mail: mdes.tax@state.mn.us
TO AVOID PENALTY, PLEASE FILE
THIS REPORT WITH EMPLOYER’S
QUARTERLY TAX REPORT LOCATION BREAKDOWN
UNEMPLOYMENT QUARTERLY
TAX REPORT (MDES - 1)
QUARTER ENDING ____________________________
DUE DATE ____________________________
WAGE BASE ____________________________
RATE ____________________________
(This rate includes the 9/100ths of 1% Workforce Enhancement Fee)
PAGE _____ OF _____
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
NUMBER OF
EMPLOYEES
1st Mo.____________
2
nd Mo.____________
3
rd. Mo.___________
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX
TOTALS FOR THIS PAGE
TOTAL GROSS WAGES
NON-TAXABLE WAGES
TAXABLE WAGES
TOTAL TAX DUE
COMPLETE FOR LAST PAGE ONLY:
THE ENTIRE LOCATION BREAKDOWN MUST
EQUAL LINES 4, 5, & 6 OF THE TAX REPORT
MDES-874 (Revised 01-2003)
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