Form 770es - Virginia Estimated Income Tax Payment Vouchers - 2012 Page 4

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2012 ESTIMATED TAX PAYMENT RECORD
Check or Money
Payment
Check or Money
Overpayment
Total Amount
Date
Order Payment
Made With:
Order Number
Credit Applied
Paid
Amount
Voucher 1
Voucher 2
Voucher 3
Voucher 4
Total

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