UI Contributions Voucher

        If you are not required to file electronically, a voucher is required to ensure your 
        payment is posted as efficiently and effectively as possible to your account. 

           PLEASE DO NOT PHOTO COPY AND REUSE VOUCHERS.

        Please return all of the following by the due date to ensure timely UI reporting:

                          x Completed Quarterly UI Report (UI5 or UI5G)
                          x Payment (if applicable)
                          x Payment Voucher Below  (if sending payment)

                PLEASE USE THE VOUCHER BELOW

                            Remove voucher and submit with payment.
                                                                   Amount Due :  $
DEPARTMENT OF LABOR AND INDUSTRY
205 6033
                                                                   Amount Paid :  $
Mail Payment To:
UI Contributions Bureau
                                                           ID           ID Type          FEIN
PO Box 6339
                                                           17456496648  01            851312321
Helena, MT 59604-6339
                                                           Voucher Type Quarter          DLN
        You may file your report or make a payment         00           03312014     L0547569664
                online at uieservices.mt.gov

174564966480185131232100033120147L0547569664