Computer-Generated Payment Voucher And Extension Forms - Form Pv, Form M-4868, Form 2 Pv, Form 355 Pv, Form 355-7004 - 2013 Page 3

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5
5
Massachusetts
Form PV
Income Tax Payment Voucher — 2013
Department of Revenue
Social Security number
Spouse’s Social Security number
Year end date
Amount enclosed
Check which form you filed:
Form 1
Staple
Form 1-NR/PY
check
here
Nonresident Composite Return
Name/address changed since 2012
Pay online at Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7002, Boston, MA 02204.

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