BUREAU OF INDIVIDUAL TAXES
PO BOX 280600
HARRISBURG, PA 17128-0600
PA-41 Payment Voucher (PA-V)
Use the 2012 form PA-V with your payment if you owe tax with your 2012 PA-41, Fiduciary Income Tax Return. Do not use this
voucher for any other purpose. Follow the instructions below.
Federal Employer Identification Number (FEIN)/ Social Security Number (SSN)
● FEIN - enter the fiduciary’s (estate or trust) nine-digit FEIN with a hyphen followed by “F.”
● SSN - If the estate has not received its FEIN from the IRS, enter SS followed by the decedent’s nine-digit Social Security
number with the hyphens.
● NO FEIN – if the trust has not yet received its FEIN from the IRS, write “APPLIEDFR” in the space provided for the FEIN.
Check Digit
Print the first two letters of the last name of the fiduciary (estate or trust).
Name and Title of Fiduciary
● Lines 1 through 4 - print the last name, first name and middle initial of the fiduciary (estate or trust).
Example:
● Estate – SMITH JOHN T ESTATE OF
● Trust – JONES MARY S TRUST
Address of Fiduciary
● Lines 5 and 6 – Print the fiduciary’s (estate or trust) complete street address. If the address has an apartment, suite or
RR number, enter after the street address.
● Line 7 – Print the name of the city. For foreign addresses, the bottom line of the address should show only the country name,
written in full (no abbreviations) and in capital letters.
● Line 8 – Print the two-digit state abbreviation.
● Line 9 – Print the five-digit ZIP Code.
Fiduciary Phone Number
Print the fiduciary’s (estate or trust) 10-digit phone number with area code including hyphens.
Payment
Carefully enter the amount of your payment.
Make the check or money order payable to the PA DEPT. OF REVENUE. Please write on your check or money order:
● the estate’s or trust’s FEIN (including “F”);
● "2012 PA-41"; and
● daytime telephone number of the estate’s or trust’s representative.
The department will need your FEIN if your check becomes separated from your PA-V. The department will need your FEIN to
accurately apply your payment.
Payment Without A PA-V
If you do not have a PA-V, make your check or money order payable to: PA DEPT. OF REVENUE. On the check or money order:
● print the estate’s or trust’s FEIN (including “F”);
● "2012 PA-41"; and
● daytime telephone number of the estate’s or trust’s representative.
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DETACH HERE
2012 PA-41 PAYMENT VOUCHER
FEIN EXAMPLE – 12-3456789F
SSN EXAMPLE – SS123456789
1200910055
FIDUCIARY
PAYMENT AMOUNT
$
Make check or money order
DEPARTMENT USE ONLY
payable to the Pennsylvania
Department of Revenue
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