2017

2017

Form ME UC-1 MAINE (CSSF) DEPARTMENT OF 2017 LABOR UNEMPLOYMENT CONTRIBUTIONS REPORT 99 *1506400* QUARTER # Name UC Employer Account No: Fed...

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Form ME UC-1

MAINE

(CSSF)

DEPARTMENT OF

2017

LABOR

UNEMPLOYMENT CONTRIBUTIONS REPORT

99 *1506400*

QUARTER #

Name

UC Employer Account No: Federal Employer ID No:

Mailing Address

Quarterly Period Covered:

2017 MM

City

State

DD

YYYY

2017 MM

DD

YYYY

ZIP Code

See page 6 for electronic filing and payment requirements and options 1.

1st Month

For each month, enter the total of all full-time and part-time workers who worked during, or

2nd Month

3rd Month

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

4.

(from schedule 2, line 15) ...................................................................................................................... 3.

$

.

EXCESS WAGES (SEE INSTRUCTIONS) ........................................................................................... 4.

$

.

$

.

UC contributions due (line 5 times line 6a) .............. 6b.

$

.

CSSF Assessment (line 5 times line 7a) ........................... 7b.

$

.

$

.

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

.

7a. CSSF rate .0006

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:

Firm’s Name (or yours, if self-employed):

Telephone: Paid Preparer EIN: Maine Payroll Processor License Number:

Address:

2D Bar Code space

Maine Revenue Services processes returns on behalf of the Maine Department of Labor — (207) 621-5120 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

SCHEDULE 2 (FORM ME UC-1) 2017 99 Name:

*1506402*

UC Employer Account No.:

Federal Employer ID No.:

2017 -

Quarterly Period Covered:

MM

DD

YYYY

2017 MM

DD

YYYY

Unemployment Contributions Wages Listing All employers designated SEASONAL by the Maine Department of Labor. See instructions for column 13 on page 5. 11. Payee Name (Last, First, MI)

12. Social Security Number

13. UC Gross Wages Paid

a.

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b.

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c.

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d.

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e.

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f.

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g.

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h.

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i.

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j.

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k.

.

l.

.

m.

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n.

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o.

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p.

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q.

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r.

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14. Total of column 13 on this page

2D Bar Code space 15. Total of columns 13 for ALL pages