Form Ri-1040es - Rhode Island Estimated Payment Coupons Page 2
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1
2Form RI-1040ES
STATE OF RHODE ISLAND
2004 Payment Coupon
DIVISION OF TAXATION * ONE CAPITOL HILL, PROVIDENCE, RI 02908-5810
NAME
Return this coupon with check or money order
DUE DATE
payable to the R.I. Division of Taxation, One
SEPTEMBER 15,
ADDRESS
Capitol Hill, Providence, R.I. 02908-5810.
2004
Please do not send cash with this coupon.
CITY
STATE
ZIP
ITE
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER, IF JOINT PAYMENT
$
1. ENTER
FILE ONLY IF YOU ARE MAKING A PAYMENT OF ESTIMATED TAX
0 0
AMOUNT DUE
AND PAID
DETACH HERE AND MAIL WITH YOUR PAYMENT
Form RI-1040ES
STATE OF RHODE ISLAND
2004 Payment Coupon
DIVISION OF TAXATION * ONE CAPITOL HILL, PROVIDENCE, RI 02908-5810
NAME
Return this coupon with check or money order
DUE DATE
payable to the R.I. Division of Taxation, One
ADDRESS
Capitol Hill, Providence, R.I. 02908-5810.
JUNE 15, 2004
Please do not send cash with this coupon.
CITY
STATE
ZIP
ITE
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER, IF JOINT PAYMENT
$
FILE ONLY IF YOU ARE MAKING A PAYMENT OF ESTIMATED TAX
1. ENTER
0 0
AMOUNT DUE
AND PAID
DETACH HERE AND MAIL WITH YOUR PAYMENT
Form RI-1040ES
STATE OF RHODE ISLAND
2004 Payment Coupon
DIVISION OF TAXATION * ONE CAPITOL HILL, PROVIDENCE, RI 02908-5810
NAME
Return this coupon with check or money order
DUE DATE
payable to the R.I. Division of Taxation, One
ADDRESS
Capitol Hill, Providence, R.I. 02908-5810.
APRIL 15, 2004
Please do not send cash with this coupon.
CITY
STATE
ZIP
ITE
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER, IF JOINT PAYMENT
$
FILE ONLY IF YOU ARE MAKING A PAYMENT OF ESTIMATED TAX
1. ENTER
0 0
AMOUNT DUE
AND PAID
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