Form D-41p - Payment Voucher For Fiduciary Income Tax - 2012

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This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
OFFICIAL USE ONLY
Vendor ID#0002
Estate or trust’s federal employer ID number
Estate or trust’s social security number
Estate or trust name
Tax period ending (MMYY)
Fiduciary’s name and title
Fiduciary’s address (number, street and apartment number if applicable)
City
State
Zip Code +4
Revised 09/12

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