Form 760-Pmt - Payment Coupon - 2002
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1Please cut
along dashed
lines below.
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this entire page!
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Your Social Security Number
Spouse’s Social Security Number
2002
PAYMENT COUPON
Form 760-PMT
Due: May 1, 2003
Make your check payable to the
Virginia Department of Taxation
0000000000 3395006 102008
.
Name(s) and Address
Amount of Payment
Mail Payment To:
VA Department of Taxation
P.O. Box 760
Richmond, VA 23218-0760
Daytime Phone Number:_______________________________
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Parent category: Financial