VIRGINIA DEPARTMENT OF TAXATION 
                          FORM 770-PMT - 2022 PAYMENT COUPON

Effective for payments made on and after July 1, 2022, Pass-Through entities must submit all unified nonresident 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 770 or Form 765 and owe tax, but did not submit payment with the return, use this form to send in 
tax payment. Submit your payment on or before the due date, to avoid penalty and interest. 
• If the Form 770 or Form 765 was filed electronically through e-File or mailed directly to the Department, make the 
  check payable to the Department of Taxation and mail the payment with the voucher below to:
                                            Virginia Department of Taxation 
                                                      P.O. Box 760 
                                                      Richmond, VA 23218-0760
• If the Form 770 was filed with the Commissioner of the Revenue for the locality, make your check payable to the 
  local Treasurer and mail the payment to the locality so that the payment will be credited to the account at the local 
  office. Form 765 cannot be filed with the Commissioner of the Revenue.
• Alternatively, if you are using software you may be able to submit your payment through e-File.  You may also be 
  able to set up your estimated payments via debit EFT with future payment dates.
Do not send a copy of the 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:
The FEIN of the estate, trust or Pass-Through entity filing a Unified Nonresident return. This must match the information on 
the return.
The phone number of the estate, trust or Pass-Through entity filing a Unified Nonresident return..
The amount of the enclosed payment. 
Make sure that the FEIN is written on the check. 

Due Date:  If the 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   770PMT   2601052   Rev. 06/22
                                                                                   Payment Type
Form 770-PMT   2022 Payment Coupon                                            770 Return Payment                         765 Return Payment
(DOC ID 511)              *No Staples Please*                          Name of Estate, Trust or Pass-Through Entity
To Be Used For Payments On Previously Filed 2022 
Fiduciary or Unified Nonresident Income Tax Returns                    Name and Title of Fiduciary or Pass-Through Entity
                                                                       Address
                                                                       City                                              State ZIP Code
0000000000000000 5118888 122009                                        Phone Number
FEIN of Estate, Trust or Pass-Through Entity
           -                                          F-001
               Calendar filers -  enter start period as 220101 and end  Tax                                                            .00
Filing Period  period as 221231.
                                                                        Penalty                                                        .00
Beginning Filing Period - __________________________________________
                                            (YYMMDD)                    Interest                                                       .00

Ending Filing Period -    __________________________________________    Amount of 
                                            (YYMMDD)                    Payment                                                        .00