(CITY)
(Clear ) Clear
(dollars only)
(DUE DATE)
(Estate or trust name)
(Federal employer ID number)
(FIDUCIARY ADDRESS 2)
(FIDUCIARY ADDRESS)
(FIDUCIARY'S NAME or TITLE)
(PAYMENT DUE)
(Postal zipcode PLUS LAST 4)
(Postal zipcode)
(Print form for processing) Print
(Social Security Number)
(STATE)
(Tax period ending (mmyy))
(VOUCHER NUMBER)
*130410710002*
2013 D 41ES
City State
D 41ES Estimated Payment for
DCW007A
District of Columbia
Estate or trust name
Estate or trust s federal employer ID number Estate or trust s social security number
Estimated Payment for Fiduciary Income Tax
Fiduciary Income Tax
Fiduciary s address (number street and apartment/suite # if applicable)
Fiduciary s name and title
Government of the
OFFICIAL USE ONLY
Quarterly payment
Rev 09/12
Tax period ending (MMYY)
This is a FILL IN format Please do not handwrite any data on this form other than your signature
Vendor ID#0002
Voucher number: Due date:
Zip Code + 4
