Form Pv - Income Tax Payment Voucher - 2004

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Massachusetts
Form PV
Income Tax Payment Voucher — 2004
Department of Revenue
Social Security number
Spouse’s Social Security number
Due date
Amount enclosed
Check which form you filed:
Form 1 Full-Year Resident
Staple
Form 1-NR/PY Nonresident/
check
Part-Year Resident
here
Name/address changed since 2003
Return this voucher with check or money order payable to: Commonwealth of Massachusetts.
Mail to: Massachusetts Department of Revenue, PO Box 7003, Boston, MA 02204.

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