Form Pv - Massachusetts Income Tax Payment Voucher - 2012

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Form PV Massachusetts Income Tax Payment Voucher
2012
First name
M.I.
Last name
Social Security number
Spouse’s first name
M.I.
Last name
Spouse’s Social Security number
Street address
Amount enclosed
$
City/Town
State
Zip
Check if name/address changed since 2011
Pay online at Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7003,
0140 136 1
Boston, MA 02204.

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