Indiana Department of Revenue
                                            Post Filing Coupon
                                            PFC-COR
                                            For Use for Tax Year 2022
                                            08/2022

Note: MUST BE INCLUDED

                                            Note: Vendor’s NACTP

Cut on line before mailing

                  POST FILING COUPON PFC         0912        9999

                               “Electronic calculation and processing of state tax 
                               liabilities serve as a convenience for Indiana taxpayers. 
                               The taxpayer remains responsible for providing accurate information 
Federal ID Number 99 9999999   and remains liable for payment of the correct amount of tax.”

Period End Date 99 99 9999
Date Due 99 99 9999            Mail and make check payable to
Tax Type   COR                 INDIANA DEPARTMENT OF REVENUE
                               P.O. BOX 1674
                               INDIANAPOLIS, IN 46206-1674
TAXPAYER NAME XXXXXXXXXXXXXXXX
ADDRESS LINE 1 XXXXXXXXXXXXXXX       Amount Due:             999999999 .00 
ADDRESS LINE 2 XXXXXXXXXXXXXXX
CITY STATE  ZIPXXXXXXXXXXXXXXXX

                                     06999999999999999999990379999999999