Form D-41p - Payment Voucher For Fiduciary Income Tax - Office Of Tax And Revenue - District Of Columbia

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D-41P Payment Voucher
See instructions on back
Print
Clear
Make check or money order payable to: DC Treasurer
FOR OFFICIAL USE ONLY
0002
VENDOR ID#
Estate or trust’s federal employer ID number
Estate or trust’s social security number
Estate or trust name
Tax period ending (MMYY)
Fiduciary’s name and title
Fiduciary’s address (number, street and apartment number if applicable)
City
State
Zip Code +4
Revised 12/10
Detach at perforation and mail the voucher, with payment attached, to the Office of Tax and Revenue, PO Box 441, Washingon, DC 20044-0441.
Print
Clear#2
Make check or money order payable to: DC Treasurer
FOR OFFICIAL USE ONLY
0002
Estate or trust’s federal employer ID number
Estate or trust’s social security number
VENDOR ID#
Estate or trust name
Tax period ending (MMYY)
Fiduciary’s name and title
Fiduciary’s address (number, street and apartment number if applicable)
City
State
Zip Code +4
Revised 12/10
2010 D-41.indd FOR FILL-INS 120710.indd 13
12/7/2010 12:45:29 PM

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