Form Mdes-1 - Employer'S Unemployment Quarterly Tax Report
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1MINNESOTA DEPARTMENT OF ECONOMIC SECURITY
Tax Accounting Section - Unemployment Tax - 390 N. Robert Street - St. Paul, MN 55101
(651) 296-3674 - FAX (651) 297-5283 TDD/TTY - (651) 297-3944
INTERNET: - E-mail: mdes.tax@state.mn.us
EMPLOYER’S UNEMPLOYMENT QUARTERLY TAX REPORT
MN UC TAX ACCOUNT NUMBER
FEDERAL ID NUMBER
NAME AND ADDRESS:
CALENDAR
QUARTER/YEAR
QUARTER ENDS
REPORT IS DUE
DO NOT ADJUST ERRORS FROM PRIOR REPORTS ON THIS FORM - SEE INSTRUCTIONS
Do not write in this space
TO AVOID PENALTY, PLEASE
q
1.
Check if tape or disk was submitted for wage detail
FILE REPORT EVEN IF NO
q
WAGES WERE PAID
2.
Check if address or status has changed. Complete
(SEE INSTRUCTIONS)
and return EMPLOYER CHANGE REQUEST form
st
nd
rd
1
Month
2
Month
3
Month
For each month, report the number of covered workers who worked
POSTMARK DATE
3.
during or received pay for the payroll period which includes the
th
12
of the month. If none, write 0.
Total gross wages paid for employment during quarter – must equal
4.
$
total wages reported on Wage Detail Report. (see line 4 instructions)
BATCH NO.
Non-Taxable Wages – wages paid in the quarter which exceed the first
5.
$
paid each employee for the calendar year __________.
$
Amount cannot exceed line 4. (see line 5 instructions)
6.
Taxable Wages – line 4 minus line 5
$
7.
U.C. Tax Due – multiply line 6 by
% (
)
$
Workforce Enhancement Fee - multiply line 6 by .09% or (.0009)
ï
8.
Not to be included in Federal Unemployment (FUTA) tax returns
$
All employers must pay the
Dislocated Worker Assessment
(see line 8 instructions)
9.
TOTAL TAX DUE – add lines 7 and 8
$
Interest – multiply line 9 by 1.5% (.015) for each month payment is
10.
$
late (see line 10 instructions)
11.
Penalty – late report (see line 11 instructions)
$
12.
PLUS: amount due on prior quarters (see line 12 instructions)
$
13.
MINUS: available credit on account (see line 13 instructions)
$
Amount Received:
TOTAL AMOUNT DUE:
Make check payable to: MINNESOTA UC FUND
14.
$
Check No. _______________ Bank _________________
SIGN HERE X____________________________________________________________________________________________________________________________
Signature of Preparer (if not Taxpayer)
Title
Date
Telephone Number
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT IS COMPLETE AND ACCURATE
SIGN HERE X ____________________________________________________________________________________________________________________________
Signature of Taxpayer
Title
Date
Telephone Number
MDES-1
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