Form It-41es - Fiduciary Estimated Tax And Extension Payment Voucher

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Form
Indiana Department of Revenue
Fiduciary Estimated Tax and Extension Payment Voucher
IT-41ES
State Form 50217
(R3 / 8-12)
For the calendar year ending
or fiscal year beginning
and ending
Federal Identification Number
of Trust or Estate (XXXXXXXXX)
Name of Trust or Estate
Name and Title of Fiduciary (Trustee, Executor, Personal Representative)
Address (Number and Street or Rural Route)
City
State
Zip/Postal Code
Estimated or Extension Payment Amount
.00
$
Place an “X” in the appropriate box to show which payment you are making:
Quarter 1 Payment
Quarter 2 Payment
Quarter 3 Payment
Quarter 4 Payment
Extension Payment
Mail form and payment to:
Indiana Department of Revenue
P.O. Box 6192
Indianapolis, IN 46206-6192
*25512111694*
25512111694

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