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Estimated Income Tax Payment Your First Name and Middle Initial Last Name Spouse s First Name and Middle Initial (if filing joint) Last Name Current Home Address - number and street, rural route City, Town or Post Office M M D D Y Y Y Y Enter your SSN(s). Apt. No. State 2023 ZIP Code Your Social Security Number Spouse s Social Security No. Daytime Phone (with area code) 94 REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 88 3 Check if this payment is on behalf of a Nonresident.

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