Form D-40p - Payment Voucher - 2012
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1
2D-40P PAYMENT VOUChER
See instructions on back
Detach at perforation and mail the voucher, with payment attached, to the Office of Tax and Revenue, PO Box 96169, Washington DC 20090-6169.
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Government of the
2012
D-40P Payment Voucher
*120401010002*
District of Columbia
This is a FILL-IN format. Please do not handwrite
any data on this form other than your signature.
If filing jointly, or filing separately on same return, see instructions on page 2
Vendor ID# 0002
Official Use Only
Your first name
Last name
M.I.
Spouse’s/registered domestic partner’s first name
Last name
M.I.
Your social security number (SSN)
Spouse’s/registered domestic partner’s SSN
Daytime telephone number
Home address (number, street and apartment)
City
State
Zip Code + 4
-
Do not enter cents, enter dollars only. To avoid penalties and interest,
$
.00
Amount of payment
your payment must be postmarked no later than April 15, 2013.
l
l
2012 D-40P P1
Payment Voucher
Revised 09/12
Print
Clear
l
2012
D-40P Payment Voucher
Government of the
*120401010002*
District of Columbia
This is a FILL-IN format. Please do not handwrite
any data on this form other than your signature.
If filing jointly, or filing separately on same return, see instructions on page 2
Vendor ID# 0002
Official Use Only
Your first name
Last name
M.I.
Spouse’s/registered domestic partner’s first name
Last name
M.I.
Your social security number (SSN)
Spouse’s/registered domestic partner’s SSN
Daytime telephone number
Home address (number, street and apartment)
City
State
Zip Code + 4
-
Do not enter cents, enter dollars only. To avoid penalties and interest,
$
.00
Amount of payment
your payment must be postmarked no later than April 15, 2013.
l
l
2012 D-40P P1
Payment Voucher
Revised 09/12
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Parent category: Financial