Form Wb101 - Mtq - Montana Employer'S Quarterly Tax Report - Unemployment Insurance/withholding - 2003 Page 2

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Mail this entire form with your check to the Montana Department of Revenue
Quarter Ending Date:
Make checks payable to the Department of Revenue
MTQ Quarterly Coupon
Customer ID
FEIN
Date
,
,
.
11a UI
,
,
.
Department of Revenue
11b WH
Do not staple your
check or
PO Box 6339
correspondence to
this coupon.
Helena MT 59604-6339
,
,
.
12 Total

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