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Form 760-PFF
 
2013 Payment Coupon for Farmers, Fishermen and Merchant Seamen
(DOC ID 764)
 
Please do not staple
To Be Used For Payments On Previously
 
Filed 2013 Individual Income Tax Returns Only
Your Social Security Number
Spouse’s Social Security Number
Mail Payment To:
 
VA Department of Taxation
 
P.O. Box 1478
 
Richmond, VA 23218-1478
 
 
 
 
 
 
 
 
 
Name(s)
Address
City
State
ZIP
Daytime Phone Number
Amount of
 
Payment
Make your check payable to the
 
Virginia Department of Taxation
.
0
 
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