Form A-115 - Prepayment Estimated Tax - 2013
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1State of Wisconsin
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DEPARTMENT OF REVENUE
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2135 RIMROCK ROAD
MAIL STOP 3-164
PO BOX 8966
MADISON WI 53708-8966
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FAX (608) 264-6884
You may also make your 2013 prepayment online via electronic funds transfer. Click here for our electronic
payment application. The tax type should be Individual Income Tax. The payment type should be W-200
Prepayment.
If you wish to prepay 100% of your 2013 income tax by mail, complete the voucher below and mail the voucher
postmarked by December 31, 2012 with your prepayment to:
Wisconsin Department of Revenue
Exceptions Review Unit
Mail Stop 3‑164
PO Box 8966
Madison WI 53708‑8966
A Form W-200, Certificate of Exemption from Withholding, will automatically be mailed to you when your
payment has been processed. You will receive 2 copies of this form. If your spouse also needs an exemption
certificate, you must send separate payments for you and your spouse.
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2013 PREPAYMENT
ESTIMATED TAX
Last name
First name
Social security number
Home address (number and street or rural route)
Telephone number
City or post office
State
Zip code
Prepayment Amount $
A-115 (R. 11-12)
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