Form Pa-40esr (I) - Declaration Of Estimated Tax
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1
2TAX YEAR
M
M
D
D
Y
Y
Y
Y
DECLARATION OF ESTIMATED TAX
DATE
FILED:
PA-40ESR (I) (08-13)
FISCAL FILERS ONLY
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
READ INSTRUCTIONS BEFORE ENTERING
M
M
D
D
Y
Y
Y
Y
DOLLAR AMOUNTS.
BEGINNING
MAKE CHECKS PAYABLE TO
DAYTIME TELEPHONE NUMBER
PA DEPARTMENT OF REVENUE
M
M
D
D
Y
Y
Y
Y
YOU MUST INCLUDE THE LAST 4 DIGITS
OF SSN AND THE FULL NAME OF THE
ENDING
PRIMARY TAXPAYER ON YOUR CHECK
LAST NAME
OR MONEY ORDER
MAIL THIS FORM WITH YOUR PAYMENT TO:
PA DEPARTMENT OF REVENUE
AMOUNT OF PAYMENT
FIRST NAME
PO BOX 280403
$
HARRISBURG PA 17128-0403
TYPE OF ACCOUNT:
P.O. BOX, APT. NO., SUITE, FLOOR, RR NO., ETC.
I – INDIVIDUAL
DECLARATION OF ESTIMATED TAX
STREET ADDRESS
CITY
STATE
ZIP CODE
DEPARTMENT USE ONLY
PRINT FORM
Reset Entire Form
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Parent category: Financial