Form Ga-V - Withholding Payment Voucher - 2016
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1
2State of Georgia Department of Revenue
KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS
Instructions
1. Download (free) the latest version of Adobe Reader.
2. Complete the worksheet below to automatically create your payment voucher.
3. Click the “Print” button to print a completed GA-V payment voucher.
4. Cut the payment voucher along the dotted line and mail the voucher and your payment only to
the address on the voucher.
DO NOT fold, staple or paper clip items being mailed.
DO NOT mail in the worksheet, keep this for your records.
GA-V Worksheet
1. GA Withholding ID:
2. FEI Number:
3. Name: ..............................
4. Street Address Line 1:
5. Street Address Line 2:
6. City:
7. State:
8. Zip:
-
0000
9. Telephone Number: ...................................................................................
10. Tax Period:...................................................................................................
Select
11. Amount Paid: ...............................................................................................
Print
Clear
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Parent category: Financial