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                                               Indiana Department of Revenue
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06                                             Post Filing Coupon
07                                             PFC-IND
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09                                             For Use for Tax Year 2023
10                                             08/2023
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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 *SSN 1   999 99 9999           and remains liable for payment of the correct amount of tax.”
51 *SSN 2   999 99 9999
52 Period End Date 99 99 9999
53 Date Due 99 99 9999            Mail and make check payable to
54 Tax Type   IND                 INDIANA DEPARTMENT OF REVENUE
55                                P.O. BOX 1674
56                                INDIANAPOLIS, IN 46206-1674
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58 FIRST MIDDLE LASTXXXXXXXXXXXXX
59 NAME 2 ONLY IF JOINT FILINGXXX     Amount Due:               999999999 .00 
60 ADDRESS LINE 1 XXXXXXXXXXXXXXX
61 ADDRESS LINE 2 XXXXXXXXXXXXXXX
62 CITY STATE ZIPXXXXXXXXXXXXXXXX
63                                    06999999999999999999990119999999999
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