Computer-Generated Payment Voucher And Extension Forms - Form Pv, Form M-4868, Form 2 Pv, Form 355 Pv, Form 355-7004 - 2013 Page 4

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5
5
Massachusetts
Form M-4868
Application for Automatic Six-Month Extension — 2013
Department of Revenue
Social Security number
Spouse’s Social Security number
Period end date
Amount enclosed
Sign here. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Your signature
Signature of paid preparer
Date
Employer Identification number of paid preparer
Social Security number or PTIN

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