State of Rhode Island Division of Taxation 
     Form BUS-V 
                                                                        23111599990101
     Business Tax Payment Voucher Form

Name                                                                    Federal employer identification number

Address                                                                 For the period ending:
                                                                                           MM/DD/YYYY
Address 2

City, town or post office     State          ZIP code                   E-mail address

Part 1:  Business Tax Type

  Check the box next to the form for which you are making a payment.  Check only one box. 

  Form RI-1065/RI-1120 - Rhode Island Corporate Income Tax

  Form RI-1120POL - Rhode Island Political Organization 
  Form T-71 - Rhode Island Gross Premium Insurance                                                  ELECTRONIC MANDATE 
                                                                        The Rhode Island Division of Taxation has an  
                                                                        electronic mandate that requires Larger Business  
  Form T-71A - Rhode Island Surplus Line Broker Gross Premium           Registrants use electronic means to file returns and  
                                                                        remit taxes beginning on January 1, 2023.  
  Form T-71SP - Rhode Island Self Procurement Insurance Premiums         
                                                                        For more information, refer to the instructions for 
  Form T-72 - Rhode Island Public Service Corporation Gross Earnings    the form which you are making this payment on  
                                                                        Taxations’ website: 
  Form T-74 - Rhode Island Banking Institution Excise                   https://tax.ri.gov/forms 
                                                                         
                                                                        To file and pay, visit Taxation’s portal:  
  Form T-86 - Rhode Island Bank Deposits                                https://taxportal.ri.gov/ 
                                                                         
  Form RI-PTE - Pass-Through Entity Election                            If you are not required to file and pay via  
                                                                        electronic means, send form and payment to: 
                                                                             R.I. Division of Taxation 
                                                                             One Capitol Hill 
                                                                             Providence, RI 02908 

Part 2:  Amount due

1 Amount enclosed..................................................................................................................... 1

                              NOTE: If payment is made online, you do not need to send this form in.  
                       For more information about Taxation’s portal, visit:  https://tax.ri.gov/online-services/tax-portal
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
belief, it is true, accurate and complete.  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
 Authorized officer signature            Print name                                  Date                                              Telephone number

 Paid preparer signature                 Print name                                  Date                                              Telephone number

 Paid preparer address        City, town or post office           State           ZIP Code                                                         PTIN

         May the Division of Taxation contact your preparer?   YES

                                                                                                                                                       Revised 
                                                                                                                                                       11/2023