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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.

For information call (804) 367-8037

Virginia Corporate Income Tax Extension

500E

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

Payment Voucher and Tentative Tax

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

Return

received by the due date of the corporate return (nonprofit - see instructions). This form

(DOC ID 502)

must be filed to receive an extension for filing even when no payment is due. Elec-

Virginia Department of Taxation

tronic Funds Transfer (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

P.O. Box 1500

tentative tax payment block below.

Check if a nonprofit corporation

Richmond, VA 23218-1500

00000000

3500411 000000

VA DEPT OF TAXATION 2601008 W (REV 7/04)

Check type of return

For taxable Year Ending

Virginia Account Number

Federal Employer's ID Number

500

500-EC

MONTH

YEAR

Name of corporation

First 4 letters of corp. name

Net tentative tax payment

Address (Number and street)

Address continued

City, State and Zip Code

Make check or money order payable to:

Virginia Department of Taxation

declare that this return (including any accompanying schedules) has been examined by

me and to the best of my knowledge and belief is a true, correct and complete return.

Signature: _________________________________________ Date: _______________ Phone No. __________________

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

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