Form Ct-1040v - Connecticut On-Line Filing Payment Voucher - 1998
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2The total amount of tax due must be paid in full. If payment is not made on or before April 15, 1999, the
tax due is subject to penalty and interest. The CT-1040V must be mailed with payment of taxes due to the
following address:
State of Connecticut
Department of Revenue Services
PO Box 5088
Hartford CT 06102-5088
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for Department Use only
CT-1040V
112
STATE OF CONNECTICUT
112
DEPARTMENT OF
1998 Connecticut On-Line Filing
REVENUE SERVICES
Payment Voucher
0
1. Enter the Amount Enclosed $
1998
2. Make Remittance Payable to: “Commissioner of Revenue Services”
1998
3. Write your Social Security Number and “OL” on your check.
1 9
4. Mail to: DRS PO Box 5088 Hartford CT 06102-5088
1 9 9 9
Your First Name
Middle Initial
Last Name
Your Social Security Number
M M
D D
C C
Y Y
M M
D D
C C
Y Y
Spouse’s Social Security Number
If a JOINT Return, Spouse’s First Name Middle Initial
Last Name
Home Address (Number and Street)
740
740
City, Town or Post Office
State
ZIP Code
OL
OL
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