Fillable Form Mc10 - Estimated Tax Deposit/payment printable pdf download

MinnesotaCare Provider Estimated Tax Deposit/Payment

MC10

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 tax-year 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.

Before You Can Make a

Pay Electronically

Pay by Credit or Debit Card

• Go to and log

• Go to payMNtax.com; or

Payment

in to e-Services; or

To ensure your payment is processed

• Call 1-855-9-IPAY-MN or

correctly, you must have a Minnesota tax ID

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

1-855-947-2966.

number. To register for a Minnesota tax ID

You’ll need your user name, password

Pay by Check

number, go to our website at

and banking information. When paying

state.mn.us and click “Starting a Business”

If you are not required to pay electroni-

electronically, you must use an account that

and then click “Register for a Minnesota

cally, you may pay by check. Complete the

is not associated with any foreign banks.

tax ID number. ” If you don’t have Internet

voucher below and mail it with your check.

access, you can register by phone at 651-

After you authorize the payment, you’ll

All information is required to process your

282-5225 or 1-800-657-3605.

receive a confirmation number. You can

payment, including your Minnesota tax ID

cancel a payment up to one business day

number.

before the scheduled payment date, if

When you pay by check, your check autho-

needed.

rizes us to make a one-time electronic fund

transfer from your account, and you may

not receive your canceled check.

Cut carefully along this line to detach.

MC10

3990

Provider Estimated Tax Deposit/Payment

Minnesota tax ID

(required)

Name of provider

FEIN

Address

City

State

Zip code

Enter the last day of your tax year. Use

mmddyy format. Example: If paying 2012

estimated tax, enter 123112.

Name of contact person

Title

Phone

Tax-year end

(mmddyy)

Make check payable to Minnesota Revenue and mail to.

AMOUNT

Minnesota Revenue, Mail Station 6100, St. Paul, MN 55146-6100

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 tax-year end date and your Minnesota tax ID.

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Form Mc10 - Estimated Tax Deposit/payment

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