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                                               Indiana Department of Revenue
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06                                             Post Filing Coupon
07                                             PFC-COR
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09                                             For Use for Tax Year 2022
10                                             08/2022
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37 Note: MUST BE INCLUDED
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41                                             Note: Vendor’s NACTP
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43 Cut on line before mailing
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45                   POST FILING COUPON PFC         0912        9999
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47                                “Electronic calculation and processing of state tax 
48                                liabilities serve as a convenience for Indiana taxpayers. 
49                                The taxpayer remains responsible for providing accurate information 
50 Federal ID Number 99 9999999   and remains liable for payment of the correct amount of tax.”
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52 Period End Date 99 99 9999
53 Date Due 99 99 9999            Mail and make check payable to
54 Tax Type   COR                 INDIANA DEPARTMENT OF REVENUE
55                                P.O. BOX 1674
56                                INDIANAPOLIS, IN 46206-1674
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58 TAXPAYER NAME XXXXXXXXXXXXXXXX
59 ADDRESS LINE 1 XXXXXXXXXXXXXXX       Amount Due:             999999999 .00 
60 ADDRESS LINE 2 XXXXXXXXXXXXXXX
61 CITY STATE  ZIPXXXXXXXXXXXXXXXX
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63                                      06999999999999999999990379999999999
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