480.9b - Payment Voucher Of Special Tax On Distributions From Individual Retirement Accounts

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480.9B
DEPARTAMENTO DE HACIENDA - DEPARTMENT OF THE TREASURY
Rev. 25 may 06
COMPROBANTE DE PAGO DE CONTRIBUCION ESPECIAL SOBRE DISTRIBUCIONES DE CUENTAS DE RETIRO INDIVIDUAL
Payment Voucher of Special Tax on Distributions from Individual Retirement Accounts
Sello de Pago
Payment Stamp
NOMBRE - Name
DIRECCION - Address
2818
CODIGO - Code
FECHA DE PAGO
Payment Date
.
___
___
/
/
NUMERO DE CUENTA
IMPORTE PAGADO
DIA-Day / MES-Month / AÑO-Year
Account Number
Amount Paid

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