Form 355S-PV Massachusetts Corporate Tax Payment Voucher
2011
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 2010
2011 0167 136