Form Ct-V - Fed/state Payment Voucher

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DO NOT USE THIS COUPON IF YOUR PAYMENT EXCEEDS $1,000
INSTRUCTIONS FOR CT-V
PA CORPORATION TAXES FED/STATE PAYMENT VOUCHER
Do not mail this coupon if payment is being made electronically.
1. Enter account information including file period begin, file period end, Revenue ID, entity name, EIN,
state of incorporation and complete mailing address.
2. Enter payments required for capital stock/foreign franchise (CS/FF), loans and corporate net income
(CNI) taxes. Also enter the total payment on Line 4. If no payment is being made for a tax, enter zero.
NOTE: All payments of $1,000 or more must be made electronically or by certified or cashier’s check
remitted in person or by express mail courier. For information on electronic filing options, visit the
e-Services Center at
3. If less than $1,000, you may mail the payment voucher and a check made payable to the PA Department
of Revenue.
PA DEPARTMENT OF REVENUE
PO BOX 280427
327 WALNUT ST FL 3
HARRISBURG, PA 17128-2005
4. Signature, title, date, email address and telephone number must be provided by a representative
of the entity.
5. Must use mmddyyyy format in all date fields.
FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING THIS COUPON.
✁
DETACH HERE BEFORE MAILING
CT-V (06-15)
DEPT USE ONLY
PA CORPORATION TAXES
FED/STATE PAYMENT VOUCHER
F
BUREAU OF CORPORATION TAXES
FILE PERIOD BEGIN
FILE PERIOD END
REVENUE ID
1. CS/FF TAX PAYMENT
.00
ENTITY NAME
EIN
2. LOANS TAX PAYMENT
.00
STATE OF INCORPORATION
3. CNI TAX PAYMENT
.00
ADDRESS
STREET
4. TOTAL PAYMENT
$
.00
0
(Add Lines 1, 2 and 3.)
CITY
STATE
ZIP
Make check payable to “PA DEPT OF REVENUE.”
Do not mail this coupon if the above payment is
being made electronically.
RESET
PRINT
SIGNATURE
TITLE
DATE
EMAIL
TELEPHONE
Please sign after printing.

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