Computer-Generated Payment Voucher And Extension Forms - Form Pv, Form M-4868, Form 2 Pv, Form 355 Pv, Form 355-7004 - 2013 Page 6

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Form 355-PV Massachusetts Corporate Tax Payment Voucher
2013
Corporation name
Federal Identification number
Payment for the year ending:
/
/
MONTH
DAY
YEAR
Street address
Check appropriate box:
Domestic corporation (0167)
Foreign corporation (0168)
City/Town
State
Zip
Amount enclosed
$
Check if 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 7005,
Boston, MA 02204.
2013 0167 136

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