Form 525-TV Fillable TSD_Payment_Voucher
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Check Amount Paid) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear All Fields) Clear (Enter 2 Character State Abbreviation) (Enter Business Name) (Enter City Name) (Enter SSN Number) (Enter SSN) (Enter Street Address) (Enter Street Address) (Enter Telephone Number (555 555 5555)) (Enter ZIP Code) (Enter Zip+4 Code) (Name or Name of Fiduciary) (Print Voucher) Print (Select Tax Type) Select (Select Tax Year) Select (Sticky Note comment mlpartee (text) (text) (text) (text) (text) (text) 525000002220000000000000004000000000007 (text) Amended Return (text) Electronically Filed (text) Paper Return (text) Taxpayer's SSN: 1 Download (free) the latest version of Adobe Reader 11 Check Type of Return : Amended Return: Paper : Electronically Filed : 12 Please Select Tax Type of Return : 13 Amount Paid : 2 Complete the worksheet below to automatically create your payment voucher 2 Spouse s SSN : 3 Click the Print button to print a completed 525 TV Individual/Fiduciary payment voucher 3 Tax Year : 4 Daytime Phone Number : 4 Cut the payment voucher along the dotted line and mail the voucher and your payment only to 5 Individual or Fiduciary Name: 5/19/2011 10:08:39 AM 525 TV AND NOT THE PRINT OPTION FROM THE WEB BROWSER MENU 525TV Individual/Fiduciary Worksheet 6 Street Address Line 1 : 7 Street Address Line 2 : 8 City : 9 State: 10 Zip: approved software company listed at http://dor georgia gov/approved software vendors ATLANTA GA 30374 0323 Atlanta Georgia 30374 0323 CHOOSING TO PRINT THIS COUPON FROM THE WEB BROWSER MENU WILL RESULT IN AN INCOMPLETE DOCUMENT WITH AN INVALID SCANLINE AND WILL DELAY PROCESSING Complete the name and address field located on the upper right side of the voucher Cut along dotted line DO NOT fold staple or paper clip items being mailed DO NOT mail in the worksheet keep this for your records For faster and more accurate posting to your account use a payment voucher with a valid scanline from the Georgia Department of Revenue s website http://dor georgia gov/ or one produced by an Georgia Department of Revenue Georgia Public Revenue Code Section 48 2 31 stipulates that taxes shall be paid in lawful money of the UnitedStates free of any expense to the State of Georgia http://www adobe com/products/acrobat/readstep2 html If you are filing a paper return; mail your return 525 TV payment voucher and your payment to the address If you are filing electronically mail only your voucher and payment to: Individual and Fiduciary Payment Voucher Individual or Fiduciary Name and Address:525 TV (Rev 06/22/15) Instructions Instructions for the Individual/Fiduciary (525 TV) Payment Voucher KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS Only complete this voucher if you owe taxes PLEASE DO NOT mail this entire page Please cut along dotted line and mail only your voucher and payment PLEASE DO NOT STAPLE PLEASE REMOVE ALL ATTACHED CHECK STUBS PLEASE DO NOT STAPLE REMOVE ALL CHECK STUBS Please write your SSN or FEIN on your check or money order PLEASEDO NOTMAIL! PO Box 740323 PO BOX 740323 Amount Paid $ Processing Center Remove your check stub to keep with your records State of Georgia Department of Revenue Taxpayer s SSN or Fiduciary FEIN Spouse s SSN (if joint or combined return) Tax Year Daytime Telephone Number Vendor Code that appears on the return the address on the voucher Type of Return: UPON COMPLETION OF THIS COUPON PLEASE CLICK THE PRINT BUTTON BELOW TO PRINT A COMPLETED