Form Ext-06 - Extension Payment Worksheet - State Of Montana 2006 Page 2
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1
2Attention
Montana Department of Revenue Cashier
Individual Extension Payment Form
Complete the payment form to ensure proper credit of your payment.
Name
__________________________________________________
Address ____________________________________________________
____________________________________________________
____________________________________________________
Phone
___________________________________________________
Please mail this entire form with your check to:
Department of Revenue
PO Box 5805
Helena, MT 59604-5805
Questions? Call us at (406) 444-6900
Make checks payable to the Department or Revenue
month
day
year
x
Extension tax Payment only
/
/
1. Year Ending Date
2. Social Security number
-
-
,
,
.
3. amount Paid
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Parent category: Financial