Form In-114 - Individual Income Estimated Tax Payment Voucher - Vermont Department Of Taxes - 1999 Page 2

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1999 VERMONT
Individual Income Estimated Tax Payment Voucher
Taxpayer’s Social Security Number
Taxpayer’s Last Name
First Name
Initial
Spouse’s Last Name
First Name
Initial
Spouse’s Social Security Number
Mailing Address (Number and Street, including Rural Route)
City, Town, or Post Office
State
Zip Code
Amount of this payment $
0 0
Fiscal Year Taxpayers
Tax Year Ending
MAIL VOUCHER TO:
VOUCHER NO.:
Vermont Department of Taxes
Due Date:
Month
Year
109 State Street
Montpelier, VT 05609-1401
IN-114 Rev. 12/98

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