VIRGINIA DEPARTMENT OF TAXATION 
             Form 760-PMT - 2022 Tax Due Return Payment Coupon

Effective  for  payments  made  on  and  after  July  1,  2022,  individuals  must  submit  all  income  tax  payments 
electronically if any payment exceeds $1,500 or the sum of all payments is expected to exceed $6,000. This 
includes estimated, extension, and return payments. Visit our website at www.tax.virginia.gov for information 
on electronic payment options. 

                     TO BE SURE THAT YOUR PAYMENT IS APPLIED CORRECTLY, 
                                      FOLLOW THESE INSTRUCTIONS:
If you filed a 2022 Form 760, Form 760PY or Form 763 and owe tax, but did not submit payment with the return, 
use this form to send tax payment.  Submit your payment on or before the due date, to avoid penalty and interest. 
     •  If the return was filed electronically through e-File   or mailed directly to the Department, make your check 
        payable to the Department of Taxation and mail the payment with the voucher below to:
                                      Virginia Department of Taxation 
                                                        P.O. Box 1478 
                                             Richmond, VA 23218-1478
     •  If the return was filed with the Commissioner of the Revenue for your locality, make your check payable 
        to your local Treasurer and mail the payment to your locality so that the payment will be credited to your 
        account at the local office. 
Do not send a copy of your return with your payment. If a copy of the return is sent, the payment will not be posted 
properly to the account.

                                COMPLETE THE PAYMENT COUPON BY  
                          INCLUDING THE FOLLOWING INFORMATION:
Your Social Security Number (SSN) and Spouse’s SSN (if filing a joint return). This must match the information 
on your return.
Your name and spouse’s name (if filing a joint return), address, and phone number.
The amount of the enclosed payment. 
Make sure that your SSN is written on the check. 
Due Date: If your full payment is not postmarked by May 1, 2023, you may be sent a bill for tax, penalty and 
interest. For additional information visit: www.tax.virginia.gov or call (804) 367-8031.

Va. Dept. of Taxation   760PMT   2601040   Rev. 06/22

Form 760-PMT   2022 Tax Due Return Payment Coupon
(DOC ID 761)          *No Staples Please*
                                                        Your Social Security Number       Spouse’s Social Security Number
To Be Used For Payments On Previously 
Filed 2022 Individual Income Tax Returns Only

0000000000 7618888 122009                                             If your return was filed through e-Filee-File or submitted directly to 
                                                                      the Department, make your check payable to the Department of 
                                                                      Taxation and mail to the VA Department of Taxation, P. O. Box 
                                                                      1478, Richmond, VA 23218-1478. 
Name(s)
                                                                      If  your  return  was  filed  with  your  local  Commissioner  of  the 
                                                                      Revenue, make your check payable to your local Treasurer  and 
Address                                                               send your payment to the locality where you filed the return. 

City                                 State           ZIP

Daytime Phone Number                                               Amount of 
                                                                   Payment                                 .0   0