Form 00-213 - Contribution To Texas Grant And Teach For Texas Loan Repayment Assistance Programs

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00-213
PRINT FORM
CLEAR FIELDS
(Rev.12-06/8)
CONTRIBUTION TO TEXAS GRANT AND TEACH FOR
Do not write in the space above
TEXAS LOAN REPAYMENT ASSISTANCE PROGRAMS
FOR COMPTROLLER’S USE ONLY
T code
90100
You may contribute to TEXAS Grant and Teach for Texas Loan Repayment Assistance Programs all or part of the
Deposit code
540
“DISCOUNT” shown on your return by filing the return and paying the tax by the due date.
If you wish to contribute to these programs:
Taxpayer number
(Use the number on your return)
- Complete your return and calculate the “TOTAL AMOUNT DUE.”
- Enter the information requested on this form and show the amount of discount you wish to contribute.
- Make your payment payable to STATE COMPTROLLER for the TOTAL of the amount due on your return
PLUS the amount contributed.
Amount of contribution
- Return this form with your tax return and payment to the COMPTROLLER.
Taxpayer name
$
Taxpayer or duly authorized agent
Address
Business phone
Date
City, state, ZIP code
For tax assistance call 1-800-252-5555 toll free nationwide, or call 512/463-4600.
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you.
Contact us at the address or toll-free number listed on this form.

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