Form Pa-40esr - Declaration Of Estimated Tax Or Estimated Withholding Tax For Fiduciaries & Partnerships
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1
2DECLARATION OF ESTIMATED TAX
OR
TAX YEAR
M
M
D
D
Y
Y
Y
Y
ESTIMATED WITHHOLDING TAX
DATE
FOR FIDUCIARIES & PARTNERSHIPS
FILED:
PA-40ESR (F/C) (05-09)
FISCAL FILERS ONLY
EMPLOYER IDENTIFICATION 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
MAIL THIS FORM WITH YOUR PAYMENT TO:
ENDING
PA DEPARTMENT OF REVENUE
PO BOX 280403
FIDUCIARY / PARTNERSHIP NAME
HARRISBURG PA 17128-0403
MUST MARK (FILL IN OVAL)
AMOUNT OF PAYMENT
NAME
continued
TYPE OF ACCOUNT:
$
.
,
,
L
L
F – FIDUCIARY (ESTATE or TRUST)
P.O. BOX, APT. NO., SUITE, FLOOR, RR NO., ETC.
C – (PARTNERSHIP, ASSOCIATION
DECLARATION OF ESTIMATED TAX
or PA S CORPORATION)
OR ESTIMATED WITHHOLDING TAX
.
STREET ADDRESS
,
,
L
L
CITY
STATE
ZIP CODE
DEPARTMENT USE ONLY
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