Form Cf-1040pv - Income Tax Payment Voucher - 2004

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CUT ON DOTTED LINES
Revidsed 10/7/2003
Due Date
CITY OF (Name of city)
CF-1040PV
May 2 2005
INCOME TAX PAYMENT VOUCHER
DATE DUE
SOCIAL SECURITY NUMBER
DOLLARS
CENTS
TAX YEAR
INCOME TAX PAYMENT
00
2004
May 2, 2005
TAXPAYER'S NAME AND ADDRESS
MAKE REMITTANCE PAYABLE TO:
TREASURER, CITY OF (CITY NAME)
MAIL CHECK WITH RETURN AND PAYMENT VOUCHER TO:
(List address where payment is to be sent)
Page 63 of 63

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