Form PV Wisconsin Payment Voucher

(Go to www.revenue.wi.gov/pay for electronic payment options)

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Taxpayer

*Last Name

*First Name

Taxpayer SSN/ITIN

Last Name

First Name

Spouse SSN/ITIN

Trust Name

FEIN

*Street

*State/Province

*City

*ZIP Code

*Telephone Number

*Return Year

*Return Type

*Amount of Payment