Form 800v - Virginia Insurance Premiums License Tax Payment Voucher - 2014
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PAYMENT OF TAX
Unless payment is made electronically, a check or money order covering the unpaid balance of the tax
must be attached to the return along with Form 800V. Checks or money orders should be made payable
to the Virginia Department of Taxation. Payments returned by the bank will be subject to a returned
payment fee of $35 in addition to any other penalties that may be incurred.
Form 800V
VIRGINIA INSURANCE PREMIUMS LICENSE TAX PAYMENT VOUCHER
(DOC ID 832)
VIRGINIA DEPARTMENT OF TAXATION
PO BOX 26179, RICHMOND, VA 23260-6179
FOR INFORMATION, CALL (804) 404-4163
You must file this voucher with your Form 800,
unless paying electronically.
0000000000000000 8328888 000000
2014
Taxable Year
Federal Employer ID Number
NAIC/License #
Attach this voucher to Form 800 with a check or
Company Name
money order made payable to Virginia Department
of Taxation.
Address (Number and Street)
Amount of this payment
City, State and ZIP Code
0 0
.
$
VA DEPT OF TAXATION 800V (REV. 05/14)
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