Taxpayer Name:
Taxpayer ID:

Payment Amount:
Receiving Bank ID:	092900383
Receiving Bank Account No.:	156041200321 - Montana Fuel Taxes DOR156041200321 - State Of Montana, Dept. of Admin.
Tax Period End Date:
Tax Type Code:	01100 - State Income Tax Withholding 0155 - Old Fund Liability Tax 13000 - Unemployment