Fillable Form Pv55 - Fire Safety Surcharge Return Payment printable pdf download

Fire Safety Surcharge Return Payment

PV55

(IG261 or IG262 filers)

IMPORTANT:

Type in the required information while this form is on the screen and print a copy. A personalized scan

line will be printed on the voucher using the information you entered. To help ensure your payment is properly credited

to your account, verify that the period end date and Minnesota tax ID number are included in the scan line.

When you print this voucher, be sure to set the Page Scaling to “None” in your Print options. DO NOT check the “Auto-

rotate and center pages” or “Shrink to fit” boxes. If they are already checked, click on the box to uncheck them.

Due Dates

Pay Electronically

Pay by Credit or Debit Card

• Go to and log

• Go to payMNtax.com; or

Your quarterly payments are due May 15,

in to e-Services; or

August 15, November 15 and February 15 of

• Call 1‑855‑9‑IPAY‑MN.

the following year.

• Call 1‑800‑570‑3329 to pay by phone.

You will be charged a fee to use this service,

When the due date falls on a Saturday,

You’ll need your Minnesota tax ID number,

which goes directly to Value Payment

Sunday or legal holiday, payments elec-

password and banking information. When

Systems (a national company that partners

tronically made or postmarked on the next

paying electronically, you must use an ac-

with federal, state and local governments to

count not associated with any foreign banks.

provide credit/debit card payment services).

business day are considered timely.

After you authorize the payment, you’ll re-

The Department of Revenue does not have

Before You Can Make a

ceive a confirmation number. You can can-

any financial agreement with Value Payment

Payment

cel a payment up to one business day before

Systems and does not receive any of its fees.

the scheduled payment date, if needed.

To ensure your payment is processed cor-

Pay by Check

rectly, you must have a Minnesota tax ID

Do not send in the voucher below unless

If you are not required to pay electroni-

number. To register for a Minnesota tax ID

you are paying by check.

cally, you may pay by check. Complete the

number:

voucher below and mail it with your check.

• Go to ; or

All information is required to process your

• Register by phone at 651‑282‑5225 or

payment, including your Minnesota tax ID

1‑800‑657‑3605.

number.

When you pay by check, your check autho-

rizes us to make a one-time electronic fund

transfer from your account, and you may

not receive your cancelled check.

Cut carefully along this line to detach.

PV55

505

Fire Safety Surcharge Return Payment

Minnesota Tax ID

(required)

Name of insurance company

Mailing address

NAIC Number

Enter the last day of the period. Example:

If making a 2013 payment, enter 033113

City

State

ZIP code

for Period 1; 063013 for Period 2; 093013

Period End Date

for Period 3; or 123113 for Period 4.

(mmddyy)

Make check payable to Minnesota Revenue and mail to:

AMOUNT

Minnesota Revenue, Mail Station 1780, St. Paul, MN 55145-1780

OF CHECK

To help ensure your payment is properly credited to your account, be sure to verify that the scan line below includes the correct period end date and your Minnesota tax ID.

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Form Pv55 - Fire Safety Surcharge Return Payment

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