Form Uia 4101 - Employer'S Quarterly Tax Payment Coupon

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UIA 4101
Authorized by
(Rev. 09-17)
MCL 421.1 et seq.
WANDA STOKES
RICK SNYDER
STATE OF MICHIGAN
TIA DIRECTOR
GOVERNOR
TALENT INVESTMENT AGENCY
Unemployment Insurance
Michelle Beebe, Senior Deputy Director
3024 W. Grand Blvd., Detroit, MI 48202
Reset Form
Employer’s Quarterly Tax Payment Coupon
Please use this payment transmittal when mailing your quarterly payment.
Make your check/money order payable to: Unemployment Insurance (UI). In order to ensure your account is
properly credited, please include your 10-digit UI Employer Account Number on your check or money order. In
order to avoid penalties and interest, your tax return and payment must be received by the following due dates:
1st Quarter (January – March) Due April 25th
2nd Quarter (April – June) Due July 25th
3rd Quarter (July – September) Due October 25th
4th Quarter (October – December) Due January 25th
Complete the section below and mail this entire form along with your payment to the address below.
Employer Name: ___________________________________
Federal Employer ID Number: ________________________
UI Employer Account No: ___________________________
(
PLEASE ENTER CORRECT EMPLOYER ACCOUNT NUMBER)
Quarter End Date [MM/DD/YYYY]: _____________________
Payment Amount Enclosed: $____________________________
Mail to Unemployment Insurance, P.O. Box 33598, Detroit, MI 48232-5598.
______________________________________________________________________________________
For UI Use Only. Do Not Write Below Line.
*041011709*
TIA is an equal opportunity employer/program.

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