<?xml version="1.0" encoding="UTF-8"?>
<StatePayment xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile H:\FSET\FSETv02.0\StateSchemas\StatePayment.xsd">
	<PaymentInstrument>
		<PaymentMethodType>DBT</PaymentMethodType>
		<ACHDebit>
			<RoutingTransitNumber>027900766</RoutingTransitNumber>
			<BankName>National exchange</BankName>
			<BankAccountNumber>000000</BankAccountNumber>
			<AccountType>1</AccountType>
			<AccountHolderType>1</AccountHolderType>
			<AccountHolderName>Sam Doe</AccountHolderName>
		</ACHDebit>
	</PaymentInstrument>
	<PaymentAmount>
		<DebitAmount>300.00</DebitAmount>
	</PaymentAmount>
	<OriginationDate>2005-03-17</OriginationDate>
	<RequestedSettlementDate>2005-03-25</RequestedSettlementDate>
	<Payor>
		<TIN>
			<TypeTIN>FEIN</TypeTIN>
			<TINTypeValue>391234567</TINTypeValue>
		</TIN>
		<PayorName>Sam Doe</PayorName>
	</Payor>
	<Contact>
		<ContactName>
			<Title>Personnel Specialist</Title>
			<FullName>Bob Doe</FullName>
		</ContactName>
		<Phone>6081112222</Phone>
		<EmailAddress>bdoe@anysite.com</EmailAddress>
	</Contact>
	<TaxPayment>
		<Taxpayer>
			<TIN>
				<TypeTIN>SSN</TypeTIN>
				<TINTypeValue>111111111</TINTypeValue>
			</TIN>
			<TaxPayerName>JANE DOE</TaxPayerName>
		</Taxpayer>
		<TaxTypeCode>
			<FTACode>150</FTACode>
			<StateTaxTypeCode>30</StateTaxTypeCode>
		</TaxTypeCode>
		<TaxPeriodEndDate>2005-03-17</TaxPeriodEndDate>
		<TaxLiabilityAmount>100.0</TaxLiabilityAmount>
	</TaxPayment>
	<TaxPayment>
		<Taxpayer>
			<TIN>
				<TypeTIN>SSN</TypeTIN>
				<TINTypeValue>222222222</TINTypeValue>
			</TIN>
			<TaxPayerName>JAMES DOE</TaxPayerName>
		</Taxpayer>
		<TaxTypeCode>
			<FTACode>150</FTACode>
			<StateTaxTypeCode>30</StateTaxTypeCode>
		</TaxTypeCode>
		<TaxPeriodEndDate>2005-03-17</TaxPeriodEndDate>
		<TaxLiabilityAmount>100.00</TaxLiabilityAmount>
	</TaxPayment>
	<TaxPayment>
		<Taxpayer>
			<TIN>
				<TypeTIN>SSN</TypeTIN>
				<TINTypeValue>333333333</TINTypeValue>
			</TIN>
			<TaxPayerName>JACKIE DOE</TaxPayerName>
		</Taxpayer>
		<TaxTypeCode>
			<FTACode>150</FTACode>
			<StateTaxTypeCode>30</StateTaxTypeCode>
		</TaxTypeCode>
		<TaxPeriodEndDate>2005-03-17</TaxPeriodEndDate>
		<TaxLiabilityAmount>100.00</TaxLiabilityAmount>
	</TaxPayment>
</StatePayment>
