Form Ui-5g - Quarterly Wage Report - 2017

MONTANA UNEMPLOYMENT INSURANCE

GOVERNMENTAL & REIMBURSABLE ACCOUNT

EMPLOYEE WAGE LISTING - Form UI-5AG

Use this form (or a facsimile) as a continuation sheet for the UI employee wage listing on the Montana Employer's Unemployment Insurance

Quarterly Wage Report for Governmental and Reimbursable Accounts - Form UI-5G (Step 2).

Employer's Name and Address:

UI Account No:

FEIN:

Quarter End:

Name of Employee

Employee’s Social

Total Wages Paid

Security Number

this Quarter

Last Name

First Name

Totals

Page No._______ of _________

For additional Employee Wage Listings, Forms UI-5AG, please photocopy a blank form or call 1-800-550-1513. Attach the completed

UI-5AG to the UI Quarterly Wage Report, form UI-5G, and mail to the Unemployment Insurance Contributions Bureau, PO Box 6339,

Helena, MT 59604-6339.

FORM UI5AG

Rev. 6/05

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