Form D-41p - Payment Voucher For Fiduciary Income Tax - 2011
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2D-41P Payment Voucher
See instructions on back.
Detach at perforation and mail the voucher, with check or money order (made payable to DC Treasurer) attached to:
Office of Tax and Revenue, PO Box 441, Washingon, DC 20044-0441.
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Clear
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 09/11
Print
Clear
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 09/11
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