Fillable Form Pv53 - Surplus Lines Tax Return Payment (Ig260 Filers) printable pdf download

Surplus Lines Tax Return Payment (

PV53

IG260 filers)

IMPORTANT:

Type in the required information while this form is on the screen and print a copy. A personalized scan

line will be printed on the voucher using the information you entered. To help ensure your payment is properly credited

to your account, verify that the period end date and Minnesota tax ID number are included in the scan line.

When you print this voucher, be sure to set the Page Scaling to “None” in your Print options. DO NOT check the “Auto-

rotate and center pages” or “Shrink to fit” boxes. If they are already checked, click on the box to uncheck them.

Due Dates

Pay Electronically

Pay by Credit or Debit Card

• Go to and log

• Go to payMNtax.com; or

Due dates for the two periods are as follows:

in to e‑Services; or

• Call 1‑855‑9‑IPAY‑MN.

• Period 1 (January 1 – June 30) is due by

• Call 1‑800‑570‑3329 to pay by phone.

Aug. 15; and

You will be charged a fee to use this service,

You’ll need your Minnesota tax ID number,

which goes directly to Value Payment

• Period 2 (July 1 – December 31) is due by

password and banking information. When

Systems (a national company that partners

Feb. 15.

paying electronically, you must use an ac-

with federal, state and local governments to

When the due date falls on a Saturday,

count not associated with any foreign banks.

provide credit/debit card payment services).

Sunday or legal holiday, payments elec-

After you authorize the payment, you’ll re-

The Department of Revenue does not have

tronically made or postmarked on the next

ceive a confirmation number. You can can-

any financial agreement with Value Payment

business day are considered timely.

cel a payment up to one business day before

Systems and does not receive any of its fees.

the scheduled payment date, if needed.

Before a Payment Can Be

Pay by Check

Do not send in the voucher below unless

Made

If you are not required to pay electroni-

you are paying by check.

cally, you may pay by check. Complete the

To ensure your payment is processed cor-

voucher below and mail it with your check.

rectly, you must have a Minnesota tax ID

All information is required to process your

number. To register for a Minnesota tax ID

payment, including your Minnesota tax ID

number:

number.

• Go to ; or

When you pay by check, your check autho-

• Register by phone at 651‑282‑5225 or

rizes us to make a one‑time electronic fund

1‑800‑657‑3605.

transfer from your account, and you may

not receive your cancelled check.

Cut carefully along this line to detach.

PV53

502

Surplus Lines Tax Return Payment

Minnesota Tax ID

(required)

Name of surplus lines broker

Mailing address

Enter the last day of the period. Use

City

State

ZIP code

mmddyy format.

Period End Date

Example: Enter 063012 for Period 1;

(mmddyy)

enter 123112 for Period 2.

AMOUNT

Make check payable to Minnesota Revenue and mail with Form IG260.

OF CHECK

To help ensure your payment is properly credited to your account, be sure to verify that the scan line below includes the correct period end date and your Minnesota tax ID.

5020200000000000000000123110000000

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Form Pv53 - Surplus Lines Tax Return Payment (Ig260 Filers)

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