State of Georgia Department of Revenue
KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS
Instructions
1. Download (free) the latest version of Adobe Reader.
2. Complete the worksheet below to automatically create your payment voucher.
3. Click the “Print” button to print a completed CR-PV.
4. Cut the payment voucher along the dotted line and mail the voucher and your payment only to
the address on the voucher.
DO NOT fold, staple or paper clip items being mailed.
DO NOT mail in the worksheet, keep this for your records.
CR PV Worksheet
1. FEI Number:
2. Name: ..............................
3. Street Address Line 1:
4. Street Address Line 2:
5. City:
6. State:
7. Zip:
-
8. Telephone Number : .........................................................
9.
Please Check All That May Apply:
Address Change
Name Change
10. Tax Period Ending: ...........................................................
Select
11. Amount Paid: .....................................................................
Print
Clear