Form Pa-V - Pa Payment Voucher - 2005
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1Instructions:
1) Check the 'Highlight Fields' box on the message bar above
2) Scroll down to the PA-V voucher below and fill-in all applicable information.
3) Use 'Tab' key to move between fields
4) Verify all information and print
5) Cut on the dotted line
6) Mail voucher along with payment to:
PA DEPT OF REVENUE
PAYMENT ENCLOSED
1 REVENUE PLACE
HARRISBURG PA 17129-0001
) You may save the completed form for your records
7
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2005 PA-V
PA PAYMENT VOUCHER
Print Form
Primary SSN
Secondary SSN
0500919006
Primary Last
Name
Primary
First Name
Phone
Secondary
Last Name
PAYMENT AMOUNT
$
Secondary
First Name
Street
Address
Address
(cont.)
DEPARTMENT USE ONLY
Make check or money order
City
State
payable to the Pennsylvania
Department of Revenue
Zip
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Parent category: Financial