Fillable Form Pv51 - Firefighter Relief Surcharge Return Payment printable pdf download

Firefighter Relief Surcharge Return Payment

PV51

(IG257 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

Pay by Credit or Debit Card

• Go to and log

• Go to payMNtax.com; or

Firefighter relief surcharge return payments

in to e-Services; or

are due three times a year:

• Call 1‑855‑9‑IPAY‑MN.

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

Due date for

You will be charged a fee to use this service,

For period ending

filing and paying

You’ll need your Minnesota tax ID number,

which goes directly to Value Payment

March 31 . . . . . . . . . . . . . . April 30

password and banking information . When

Systems (a national company that partners

paying electronically, you must use an ac-

with federal, state and local governments to

May 31 . . . . . . . . . . . . . . . . June 30

count not associated with any foreign banks .

provide credit/debit card payment services) .

Oct . 31 . . . . . . . . . . . . . . . . Nov . 30

After you authorize the payment, you’ll re-

When the due date falls on a weekend or

The Department of Revenue does not have

ceive a confirmation number . You can can-

legal holiday, payments electronically made

any financial agreement with Value Payment

cel a payment up to one business day before

or postmarked on the next business day are

Systems and does not receive any of its fees .

the scheduled payment date, if needed .

considered timely .

Pay by Check

Do not send in the voucher below unless

You must make separate payments for each

If you are not required to pay electroni-

you are paying by check.

period .

cally, you may pay by check. Complete the

voucher below and mail it with your check .

Before You Can Make a

All information is required to process your

payment, including your Minnesota tax ID

Payment

number .

To ensure your payment is processed cor-

When you pay by check, your check autho-

rectly, you must have a Minnesota tax ID

rizes us to make a one-time electronic fund

number . To register for a Minnesota tax ID

transfer from your account, and you may

number:

not receive your cancelled check .

• Go to ; or

• Register by phone at 651‑282‑5225 or

1‑800‑657‑3605.

Cut carefully along this line to detach.

If there is zero surcharge for the period, there is nothing you need to do. Do not send the voucher.

PV51

078

Firefighter Relief Surcharge Return Payment

Minnesota Tax ID

(required)

Name of insurance company

Mailing address

NAIC Number

Enter the last day of the period.

City

State

ZIP code

Example: If making a 2013 payment,

Period End Date

enter 033113 for Period 1; 053113 for

(mmddyy)

Period 2; or 103113 for Period 3.

AMOUNT

Make check payable to Minnesota Revenue and mail with Form IG257.

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.

0780200000000000000000123110000000

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Form Pv51 - Firefighter Relief Surcharge Return Payment

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