Form Mdes-1a - Employer'S Unemployment Annual Tax Report
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1MINNESOTA DEPARTMENT OF ECONOMIC SECURITY
Unemployment Tax Office - 390 Robert St N - St. Paul, MN 55101
(651) 296-3674 v FAX – (651) 297-5283 v TDD/TTY – Dial 711
EMPLOYER'S UNEMPLOYMENT ANNUAL TAX REPORT
MINNESOTA UNEMPLOYMENT TAX NUMBER:
FEDERAL ID NUMBER:
CALENDAR YEAR
REPORT IS DUE
TO AVOID PENALTY, PLEASE FILE REPORT EVEN IF NO WAGES WERE PAID - SEE INSTRUCTIONS.
PLEASE NOTE
ONLY
NOT
: This form is for use by Authorized Annual Filers
- it is
to be submitted in conjunction with Quarterly UI Reports.
o
o
Check box if wage detail information is submitted on
Check box if address or business status has changed. Complete
MAGNETIC TAPE or DISK.
and return the REPORT OF CHANGE form.
DO NOT ADJUST WAGE ERRORS FROM PRIOR REPORTS ON THIS FORM - SEE INSTRUCTIONS.
1.
GROSS WAGES PAID FOR EMPLOYMENT during the year. Amount must equal
total wages reported on Wage Detail Reports for the year See line 1 instructions.
$
2.
NON-TAXABLE WAGES - Wages paid in the year which exceed the first
Amount on Line 4 is to
$ _______________ paid each employee for the calendar year. Amount cannot
be used when
- $
exceed Line 1. See line 2 instructions.
completing Federal
Form 940.
3.
TAXABLE WAGES - Subtract Line 2 from Line 1.
$
=
4.
UI TAX DUE - Multiply Line 3 by _____________% (_______________).
$
5.
WORKFORCE ENHANCEMENT FEE DUE - Multiply Line 3 by .09% ( .0009).
+ $
6.
TOTAL TAX DUE - Add lines 4 and 5.
$
=
7.
INTEREST - 1.5% (.015) of tax per month, if applicable See line 7 instructions.
+ $
8.
PENALTY - for late filing of report. See line 8 instructions.
+ $
9.
SUBTRACT: AVAILABLE CREDIT ON ACCOUNT. See line 9 instructions.
- $
TOTAL AMOUNT PAID:
$
Check No. _________ Bank ________________________
Make Check Payable to: MINNESOTA UI FUND
PLEASE DO NOT WRITE IN THIS SPACE.
POSTMARK DATE:
BATCH NUMBER:
AMOUNT RECEIVED:
SIGN HERE X
SIGNATURE OF PREPARER
DATE
TITLE
TELEPHONE NUMBER
(IF NOT TAXPAYER)
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS REPORT IS COMPLETE AND CORRECT.
SIGN HERE X
SIGNATURE OF TAXPAYER
DATE
TITLE
TELEPHONE NUMBER
INTERNET: v E-mail: mdes.tax@state.mn.us
MDES-1A (Revised 01/2003)
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