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4 State of Rhode Island Division of Taxation 4
5 Form BUS-V 5
6 23111599990101 6
Business Tax Payment Voucher Form
7 7
8 Name Federal employer identification number 8
9 9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999 10
11 Address For the period ending: 11
12 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 12/31/2023MM/DD/YYYY 12
13 Address 2 13
14 14
15 15
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCity, town or post office State ZIP code E-mail address
16 16
17 XXXXXXXXXXXXXXXXXXXXXXXXX XX 99999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 17
18 18
19 19
20 Part 1: Business Tax Type 20
21 21
22 Check the box next to the form for which you are making a payment. Check only one box. 22
23 23
24 Form RI-1065/RI-1120 - Rhode Island Corporate Income Tax 24
25 25
26 Form RI-1120POL - Rhode Island Political Organization 26
27 Form T-71 - Rhode Island Gross Premium Insurance ELECTRONIC MANDATE 27
28 The Rhode Island Division of Taxation has an 28
29 electronic mandate that requires Larger Business 29
30 Form T-71A - Rhode Island Surplus Line Broker Gross Premium Registrants use electronic means to file returns and 30
31 remit taxes beginning on January 1, 2023. 31
32 Form T-71SP - Rhode Island Self Procurement Insurance Premiums 32
33 For more information, refer to the instructions for 33
34 Form T-72 - Rhode Island Public Service Corporation Gross Earnings the form which you are making this payment on 34
Taxations’ website:
35 35
Form T-74 - Rhode Island Banking Institution Excise https://tax.ri.gov/forms
36 36
37 To file and pay, visit Taxation’s portal: 37
38 Form T-86 - Rhode Island Bank Deposits https://taxportal.ri.gov/ 38
39 39
40 Form RI-PTE - Pass-Through Entity Election If you are not required to file and pay via 40
41 electronic means, send form and payment to: 41
42 R.I. Division of Taxation 42
43 One Capitol Hill 43
44 Providence, RI 02908 44
45 45
46 Part 2: Amount due 46
47 47
48 1 Amount enclosed..................................................................................................................... 1 9999999999 99 48
49 49
50 50
NOTE: If payment is made online, you do not need to send this form in.
51 For more information about Taxation’s portal, visit: https://tax.ri.gov/online-services/tax-portal 51
52 52
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
53 belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. 53
54 Authorized officer signature Print name Date Telephone number 54
55 XXXXXXXXXXXXXXXXXXXXX 12/31/2022 (999) 999-9999 55
56 Paid preparer signature Print name Date Telephone number 56
57 57
58 XXXXXXXXXXXXXXXXXXXXX 12/31/2022 (999) 999-9999 58
59 Paid preparer address City, town or post office State ZIP Code PTIN 59
60 XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX XX 99999 P99999999 60
61 61
62 May the Division of Taxation contact your preparer? YES 62
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34567890123456789012345678901234567890123456789012345678901234567890123456789012Revised
11/2023