Form Me Uc-1 - Unemployment Contributions Report - 2016
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1
2MAINE
UNEMPLOYMENT
Form ME UC-1
CONTRIBUTIONS
(CSSF)
99
DEPARTMENT OF
REPORT
LABOR
2016
*1506400*
QUARTER #
Name
UC Employer Account No:
Federal Employer ID No:
Mailing Address
Quarterly
-
2016
2016
Period Covered:
MM
DD
YYYY
MM
DD
YYYY
City
State
ZIP Code
See page 6 for electronic fi ling and payment requirements and options
1st Month
2nd Month
3rd Month
1.
For each month, enter the total of all full-time and part-time workers who worked during, or
received pay reportable for unemployment insurance purposes for the payroll period which
includes the 12th of each month. If you had no employment in the payroll period, enter zero (0) ....... 1.
2.
Number of female employees included on line 1. If none, enter zero (0) ............................................. 2.
3.
Total unemployment contributions gross wages paid this quarter
.
(from schedule 2, line 15) ...................................................................................................................... 3.
$
.
4.
EXCESS WAGES (SEE INSTRUCTIONS) ........................................................................................... 4.
$
NOTE: THE TAXABLE WAGE BASE IS $12,000 FOR EACH EMPLOYEE
.
5.
Taxable wages paid in this quarter (line 3 minus line 4) ........................................................................ 5.
$
.
.
6a. UC contribution rate
UC contributions due (line 5 times line 6a) .............. 6b.
$
.
.0006
7a. CSSF rate
CSSF Assessment (line 5 times line 7a) ........................... 7b.
$
Note: The CSSF assessment does not apply to direct reimbursable employers. See instructions.
.
8.
Total contributions and CSSF assessment due (line 6b plus line 7b) .................................................... 8.
$
Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.
Signature:
Date:
Print Name:
Telephone:
Contact Person Email:
For Paid Preparers Only
Paid Preparer’s Signature:
Date:
Telephone:
Firm’s Name (or yours, if
self-employed):
Paid Preparer EIN:
Maine Payroll Processor
Address:
License Number:
Maine Revenue Services processes returns on behalf of the
Maine Department of Labor
2D Bar Code space
If enclosing a check, make check payable to:
If not enclosing a check,
Treasurer, State of Maine
MAIL RETURN TO:
and MAIL WITH RETURN
TO:
MAINE REVENUE SERVICES
MAINE REVENUE SERVICES
P.O. BOX 1065
P.O. BOX 1064
AUGUSTA, ME 04332-1065
AUGUSTA, ME 04332-1064
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