Montana Form Ui-5a - Mtq Unemployment Insurance Employee Wage Listing
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1MONTANA
MTQ Unemployment Insurance
UI-5A
Employee Wage Listing
Rev. 5-03
Instructions: Please type or print entries on this report using black ink.
Please use this form for Step 2 on the MTQ Quarterly Tax Report. Enclose completed form UI-5A with the
MTQ form.
Employer’s Number, Name and Address
Customer ID:
FEIN:
Quarter:
Employee’s Social Security Number
Employee’s Name
Total Wages Paid
Excess Wages
Last Name
First Name
This Quarter
This Quarter
Total of this page
For additional Employee Wage Listing Form UI-5A, please photocopy original or call 1-800-550-1513
803
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