Form Mml - Metalliferous Mines License Tax Page 3
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3Clear Form
Metalliferous Mines License Tax
(MML)
Payment Instructions
Attention: Montana Department of Revenue Cashier
Complete the payment voucher below to ensure proper credit of your payment. If you are paying taxes for multiple
periods, submit a separate check or money order and a separate voucher for each period. On the memo line of your
check, please note your FEIN or account ID and the reporting period for which the payment applies.
Boxes 1 and 2 – Print an “X” in one box only for the type of payment you are remitting:
Check box 1, if your payment is for an original return for any period.
Check box 2, if your payment is for an amended return.
Box 3 –
Enter the reporting period for which this payment applies.
Box 4 –
Enter your federal employer identification number (FEIN).
Box 5 –
Enter the amount you are remitting. (This amount should be the same amount as reported on line 27 of
your return).
Name __________________________________________________________________
Address _______________________________________________________________
_______________________________________________________________
City, State, Zip Code ______________________________________________________
Phone ____________________________
Mail this form with your payment and return (if applicable) to:
Department of Revenue
PO Box 5805
Helena, MT 59604-5805
Questions? Call (406) 444-6900.
Make check or money order payable to the Department of Revenue.
Metalliferous Mines License Tax
Payment Form
month
day
year
1. Original return
3. Period ending
/
/
2. Amended return
4. Federal employer
identification
number (FEIN)
5. Amount paid
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