Indiana Department of Revenue
                                            Post Filing Coupon
                                            PFC-IND
                                            For Use for Tax Year 2023
                                            08/2023

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 
*SSN 1   999 99 9999           and remains liable for payment of the correct amount of tax.”
*SSN 2   999 99 9999
Period End Date 99 99 9999
Date Due 99 99 9999            Mail and make check payable to
Tax Type   IND                 INDIANA DEPARTMENT OF REVENUE
                               P.O. BOX 1674
                               INDIANAPOLIS, IN 46206-1674
FIRST MIDDLE LASTXXXXXXXXXXXXX
NAME 2 ONLY IF JOINT FILINGXXX     Amount Due:               999999999 .00 
ADDRESS LINE 1 XXXXXXXXXXXXXXX
ADDRESS LINE 2 XXXXXXXXXXXXXXX
CITY STATE ZIPXXXXXXXXXXXXXXXX
                                   06999999999999999999990119999999999