Form 760-Pmt - Payment Coupon - 2004 printable pdf download

BE SURE YOUR PAYMENT IS APPLIED CORRECTLY.

FOLLOW THESE INSTRUCTIONS:

This voucher can ONLY be used to submit payment for your ELECTRONICALLY filed returns.

An electronically filed return is a return you or your tax preparer completed AND submitted

with the use of tax preparation software or with the use of an internet based application.

Never send a paper copy of your ELECTRONICALLY filed return with your payment. If a

paper copy of the return is sent, the payment will not be properly posted to the account.

Complete the Payment Coupon by including the following information:

Your Social Security Number and Spouse’s Social Security Number (if filing a joint return).

IMPORTANT NOTE: The Social Security Number used for “Your Social Security Number”

MUST match the “Your Social Security Number” used on the return.

Your name and spouse’s name (if filing a joint return), address, and phone number.

The amount of the enclosed payment.

Make sure that your Social Security Number is written on the check.Mail your payment and

the payment coupon below to :

Virginia Department of Taxation

P.O. Box 1478

Richmond, VA 23218-1478

You may also pay your tax online using our web payment program. Log on to our website

at for additional information.

Please note that if your full payment is not postmarked by May 2, 2005, you will be sent

a bill for tax, penalty and interest. For additional information visit our web site at

or call (804) 367-8031.

Detach Form 760-PMT here. Complete this form and mail it with your check to the address shown on the form.

Please do not staple

Your Social Security Number

Spouse’s Social Security Number

2004 PAYMENT COUPON

Form 760-PMT

TO BE USED FOR PAYMENTS ON

ELECTRONICALLY FILED RETURNS ONLY

Make your check payable to the

Due: May 2, 2005

Virginia Department of Taxation

00000000

3395006 104000

Amt of Payment g

Name(s) and Address

Mail Payment To:

VA Department of Taxation

P.O. Box 1478

Richmond, VA 23218-1478

Daytime Phone Number:_______________________________

Form 760-Pmt - Payment Coupon - 2004