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Form E-6 - Request For Indiana Corporate Estimated Quarterly Income Tax Returns - 2003

INDIANA DEPARTMENT OF REVENUE

Form

Request for Indiana Corporate Estimated Quarterly

E-6

(9/03)

Income Tax Returns (Form IT-6)

State Form 49102

Document Locator Number

Federal Identification Number

Indiana Taxpayer Identification Number

Location

Check if this is for a New Estimated Account

Check if new address

A. Name of Corporation or Organization

B. Street

C. City

D. State

E. Zip Code

F. Indiana County

H. Tax Year Ending (month & year)

Month

Year

If you are remitting a payment with this

form, indicate quarter and amount paid:

Quarter

Amount

(Enter 1, 2, 3, 4, or 5)

Make check payable to

Indiana Department of Revenue

Check one option below - Request for preprinted Corporate Income Tax IT-6 returns

P. Enter next starting quarter needed:

No returns needed, explain:

Signature

Telephone

Title

Date

Mail the completed Form E-6 to: Indiana Department of Revenue, Returns Processing Center,

100 N. Senate Avenue, Indianapolis, Indiana 46204-2253

Form E-6 - Request For Indiana Corporate Estimated Quarterly Income Tax Returns - 2003