Form Un 049 PDF Details

Form Un 049 is an IRS form that businesses use to request a tax exemption for their products. The form is used to document the business's history, products, and sales data. Filling out Form Un 049 can be complicated, so it's important to consult with an accountant or tax specialist before submitting the form. Thankfully, there are many online resources available that can help you understand what information is required on Form Un 049. By taking the time to research and complete the form correctly, you can save yourself from potential penalties and taxes down the road.

This information will allow you to grasp better the details of the form un 049 before you start filling it out.

QuestionAnswer
Form NameForm Un 049
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namespatient responsibility form, ies, Issuer, California

Form Preview Example

UIA 1718

 

 

 

Authorized by

(Rev. 06-19)

 

 

 

MCL 421.1 et seq.

 

 

 

STATE OF MICHIGAN

 

 

GRETCHEN WHITMER

DEPARTMENT OF LABOR AND ECONOMIC OPPORTUNITY

JEFF DONOFRIO

 

GOVERNOR

UNEMPLOYMENT INSURANCE AGENCY

DIRECTOR

 

 

 

 

 

 

 

 

 

 

 

 

 

Mail Date:

Claimant’s Statement of Wages

Employers are required to report quarterly wages for each employee to the Unemployment Insurance Agency (UIA). A claim for unemployment benefits is based on these reported wages. You were sent a Monetary Determination that provided information regarding your claim for unemployment benefits. This monetary determination showed you the

wages reported by your employers and/or informed you that an employer(s) did not report wages for you.

This Form UIA 1718, Claimant’s Statement of Wages, must be completed by you if either you disagree with the

wages reported by an employer or an employer did not report wages for you at all. Carefully read and follow the directions to complete this form. Mail to the Unemployment Insurance Agency, P.O. Box 169, Grand Rapids, MI 49501-0169 or Fax at 1-517-636-0427.

Check the reason you are completing this form:

Wages earned with _________________________________that I included on my claim for unemployment

Name of Employer

benefits were not included in the calculation of my Monetary Determination.

I disagree with the wages reported by ______________________________ as shown on my Monetary

Name of Employer

Determination.

I never worked for or was not paid by _______________________________ as shown on my Monetary

Name of Employer

Determination and to request the reported wages not be used. Complete Section E only.

Section A - Claimant Information

____________________________________________

_________________________________

First and Last name

Social Security Number

Section B - Employer Information

____________________________________________

_________________________________

Name of Company or Business

 

Owner/Employer Name

____________________________

_________________________

___________________________

Telephone Number

UIA Employer Account Number

Federal Employer Identification Number (FEIN)

____________________________________________________________________________________________

Address

City

State

Zip Code

Section C - Employment Information

 

 

 

Physical location of your employment: _____________________________________________________________

Type of work you performed or your job title: ________________________________________________________

*017181906* UIA is an equal opportunity employer/program.

UIA 1718 (Rev. 06-19)

How were you paid?

Cash Check

Direct deposit

Letter ID:

Other - explain: ____________________

Was there other remuneration (e.g. bonuses, commissions, 401K, room and board, etc.) in your wages?

No

Yes - explain:

Were deductions made from your pay (e.g. FICA, income taxes, etc.) in your wages?

No

Total gross wages during current calendar year: $____________________

actual

Total gross wages during preceding calendar year: $__________________

actual

Were there other employees?

No

Yes - how many? ______________

 

Is the employer still operating?

No

Yes

 

Additional comments:

 

 

 

Yes

estimated

estimated

Section D - Quarterly Wage Information

You must report the quarterly gross wages (before taxes) on the chart on the next page. There are four calendar quarters per year. The quarters are numbered and are the same from year to year. Each quarter contains three

calendar months as follows:

1st Quarter

January 1

through

March 31

2nd Quarter

April 1

through

June 30

3rd Quarter

July 1

through

September 30

4th Quarter

October 1

through

December 31

The involved quarters are the same quarters that are shown on your Monetary Determination under the heading

“Monetary Determination Calculations”. Label the chart on the next page with the same quarter dates.

If you are completing this form because wages earned with an employer that you included on your claim were not used in the calculation of your Monetary Determination, complete all quarters that contained wages from that employer.

If you are completing this form because you disagree with the wages reported by your employer, complete only the quarters that you disagree with.

If your address changes, it is important to update it with the Unemployment Insurance Agency.

If you have questions, you may contact us through your MiWAM account or by calling 1-866-500-0017. For telephone or Local Office hours of operation, visit www.michigan.gov/uia. TTY service is available at 1-866-366-0004.

UIA 1718

Letter ID:

(Rev. 06-19)

 

These quarterly charts allow you to enter wage information per week to help you determine your quarterly total wages. If you know your gross wages for

each quarter, complete only the Total Quarterly Wage box for each involved quarter. Wages are reported in the quarter they are paid to you.

Example: You may have worked during the last week of March (1st quarter), but you were not paid until April (2nd quarter). These wages must be reported in the 2nd quarter (the quarter containing the date you were PAID).

You are required to send in clear, legible proof of wages to support the information you provide on this form. This can include check stubs, W-2s, payroll records, or a letter from the employer with payroll information. Proof of wages must be included in the order for the Unemployment Insurance Agency to use the information you are providing.

Quarter ___

Year ______

Quarter ___

Year ______

Quarter ___

Year ______

Quarter ___

Year ______

Quarter ___

Year ______

WEEK PAID

GROSS WAGES

WEEK PAID

GROSS WAGES

WEEK PAID

GROSS WAGES

WEEK PAID

GROSS WAGES

WEEK PAID

GROSS WAGES

PAID

PAID

PAID

PAID

PAID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

TOTAL

 

TOTAL

 

TOTAL

 

TOTAL

 

Quarterly

 

Quarterly

 

Quarterly

 

Quarterly

 

Quarterly

 

Wages

 

Wages

 

Wages

 

Wages

 

Wages

 

 

 

 

 

 

 

 

 

 

 

Section E - Certification Statement

Certification: I certify that the information I have reported is true and correct. I understand that if I intentionally make a false statement, misrepresent facts or conceal material information, I may be required to pay damages and could be subject to criminal prosecution.

_____________________________________________________

_______________________

Signature

Date

*017181906* UIA is an equal opportunity employer/program.

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