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Form 500e - Virginia Corporate Income Tax Extension Payment Voucher And Tentative Tax Return

Please cut

along dashed

lines below.

Do not submit

this entire page.

Virginia Corporate Income Tax Extension

For information call (804) 367-8037

500E

An extension of six months, or until 30 days after the extended due date for the federal return,

Payment Voucher and Tentative Tax Return

whichever is later, will be granted provided that this form and payment of tax due are received by

(DOC ID 502)

Virginia Department of Taxation

the due date of the corporate return (nonprofit - see instructions). This form must be filed to

receive an extension for filing even when no payment is due. Electronic Funds Transfer

P.O. Box 1500

(EFT) filers may either submit this form or may report a zero EFT corporate extension. If no

payment is due when submitting this form, enter a zero in the net tentative tax payment block below.

Richmond, VA 23218-1500

Check if a nonprofit corporation

00000000

3500411 000000

Check type of

For taxable Year Ending

Virginia Account Number

Federal Employerís ID Number

return

500

MONTH

YEAR

500S

Name of corporation

First 4 letters of corp. name

Address (Number and street)

Net tentative

Address continued

tax payment

City, State and Zip Code

Make check or money order payable to:

Virginia Department of Taxation

declare that I have examined this return and to the best of my knowledge and belief it is true, correct and complete.

Signature: __________________________________________________

Date: ____________

Telephone No. (

) ______________________

VA DEPT OF TAXATION 2601008 (REV 11/03) WEB

Form 500e - Virginia Corporate Income Tax Extension Payment Voucher And Tentative Tax Return

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