Form Pv59 - Joint Self-Insurance Tax Return Payment

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PV59
Joint Self-Insurance Tax Return Payment
(IG263 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 (free)
Pay by Credit or Debit Card
Go to , log in
The due date for filing Form IG263 and pay-
(fees apply)
to e-Services and follow the prompts for a
ing the tax due is March 1 of the following
• Go to payMNtax.com; or
business to make a joint self-insurance tax
year.
• Call 1‑855‑9‑IPAY‑MN.
return payment; or
When the due date falls on a Saturday, Sun-
• Call 1‑800‑570‑3329 to pay by phone.
You will be charged a fee to use this service,
day or legal holiday, payments electronically
which goes directly to Value Payment
For both methods, you’ll need your Minne-
made or postmarked on the next business
Systems (a national company that partners
sota tax ID number, password and banking
day are considered timely.
with federal, state and local governments to
information. When paying electronically,
provide credit/debit card payment services).
you must use an account not associated
Before a Payment Can Be
with any foreign banks.
The Department of Revenue does not have
Made
Note: If you’re using e-Services for the first
any financial agreement with Value Payment
To ensure your payment is processed cor-
time and you need a temporary password,
Systems and does not receive any of its fees.
rectly, you must have a Minnesota tax ID
call our Business Registration Office at 651‑
Pay by Check
number. To register for a Minnesota tax ID
282‑5225 or 1‑800‑657‑3605.
number:
If you are not required to pay electroni-
After you authorize the payment, you’ll re-
cally, you may pay by check. Complete the
• Go to and
ceive a confirmation number. You can can-
voucher below and mail it with your check.
click “Register for a Minnesota tax ID
cel a payment up to one business day before
All information is required to process your
number” on the e-Services menu; or
the scheduled payment date, if needed.
payment, including your Minnesota tax ID
• Register by phone at 651‑282‑5225 or
number.
Do not send in the voucher below unless
1‑800‑657‑3605.
you are paying by check.
When you pay by check, your check autho-
rizes us to make a one-time electronic fund
transfer from your account, and you may
not receive your cancelled check.
Cut carefully along this line to detach.
PV59
076
Joint Self-Insurance Tax Return Payment
Minnesota Tax ID
(required)
Name of insured
Mailing address
Enter the last day of the tax year.
City
State
ZIP code
Example: If making a 2013 payment,
Period End Date
enter 123113.
u
(mmddyy)
AMOUNT
Make check payable to Minnesota Revenue and mail with Form IG263.
OF CHECK
00
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.
0760200000000000000000123110000000
000000
0000000000000000000000002

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