Fillable Form Pv59 - Joint Self-Insurance Tax Return Payment printable pdf download

PV59

Joint Self-Insurance Tax Return Payment

(IG263 filers)

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 period 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.

Due Dates

Pay Electronically (free)

Pay by Credit or Debit Card

Go to , log in

The due date for filing Form IG263 and pay-

(fees apply)

to e-Services and follow the prompts for a

ing the tax due is March 1 of the following

• Go to payMNtax.com; or

business to make a joint self-insurance tax

year.

• Call 1‑855‑9‑IPAY‑MN.

return payment; or

When the due date falls on a Saturday, Sun-

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

You will be charged a fee to use this service,

day or legal holiday, payments electronically

which goes directly to Value Payment

For both methods, you’ll need your Minne-

made or postmarked on the next business

Systems (a national company that partners

sota tax ID number, password and banking

day are considered timely.

with federal, state and local governments to

information. When paying electronically,

provide credit/debit card payment services).

you must use an account not associated

Before a Payment Can Be

with any foreign banks.

The Department of Revenue does not have

Made

Note: If you’re using e-Services for the first

any financial agreement with Value Payment

To ensure your payment is processed cor-

time and you need a temporary password,

Systems and does not receive any of its fees.

rectly, you must have a Minnesota tax ID

call our Business Registration Office at 651‑

Pay by Check

number. To register for a Minnesota tax ID

282‑5225 or 1‑800‑657‑3605.

number:

If you are not required to pay electroni-

After you authorize the payment, you’ll re-

cally, you may pay by check. Complete the

• Go to and

ceive a confirmation number. You can can-

voucher below and mail it with your check.

click “Register for a Minnesota tax ID

cel a payment up to one business day before

All information is required to process your

number” on the e-Services menu; or

the scheduled payment date, if needed.

payment, including your Minnesota tax ID

• Register by phone at 651‑282‑5225 or

number.

Do not send in the voucher below unless

1‑800‑657‑3605.

you are paying by check.

When you pay by check, your check autho-

rizes us to make a one-time electronic fund

transfer from your account, and you may

not receive your cancelled check.

Cut carefully along this line to detach.

PV59

076

Joint Self-Insurance Tax Return Payment

Minnesota Tax ID

(required)

Name of insured

Mailing address

Enter the last day of the tax year.

City

State

ZIP code

Example: If making a 2013 payment,

Period End Date

enter 123113.

(mmddyy)

AMOUNT

Make check payable to Minnesota Revenue and mail with Form IG263.

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 period end date and your Minnesota tax ID.

0760200000000000000000123110000000

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0000000000000000000000002

Form Pv59 - Joint Self-Insurance Tax Return Payment

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