(Address line 1)
(Address line 2)
(Clear form for next client) Clear
(dollars only) $ 00
(First name of spouse/ domestice partner)
(Last name of spouse/ domestice partner)
(Middle initial spouse/ domestice partner)
(Postal zipcode PLUS LAST 4)
(Postal zipcode)
(print form for processing) Print
(Quarterly payment amount due)
(Spouse/ domestic partner ssn)
(State)
(text)
(Your first name)
(Your last name)
(Your M I name)
(Your ssn)
*130400310002*Government of the
2013 D 40ES
2013 D 40ES Estimated Payment for
Address (number street and apartment number if applicable)
any data on this form other than your signature
City State Zip Code + 4
DCE007I
DCE007I*130400310002*Government of the
District of Columbia
Estimated Payment for Individual Income Tax
Individual Income Tax
OFFICIAL USE ONLY
Quarterly payment
This is a FILL IN format Please do not handwrite
Vendor ID#0002
Voucher number: Due date:
Your first name middle initial last name (Leave a space between names and initial )
Your social security number (SSN) Spouse s/partner s SSN
Your spouse s/registered domestic partner s first name middle initial last name (Leave a space between names and initial )
