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 03                                                                                                                                                                                                 Mail This Form With Remittance Payable To:                                                               03 
 04                                 DELAWARE DIVISION OF REVENUE                                                                                                                                    Delaware Division of Revenue                                                                             04 
                                    FORM 1100-P ā€“ ā€œSā€ CORPORATION PERSONAL INCOME TAX                                                                                                               P.O. Box 830, Wilmington, DE 19899-0830
 05                                 ACCOUNT NUMBER                      VERIFY BUSINESS FEIN               CALENDAR OR FISCAL YEAR ENDING                                                           DUE ON OR BEFORE                                                VOUCHER                                  05 
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                                                                                                                                    Check Here If A
 11                                                                                                                                 Request For                                                                                                                                                              11 
 12                                                                                                                                 Change Form Is         BALANCE DUE FROM LINE 3 OF WORKSHEET                                                                                                              12 
                                                                                                                                    Being Filed
                                                                                                                                                                                    (         OF ESTIMATED TAX FOR THE YEAR)
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 15                                                                                                                                                        $                                                                                                                                                 15 
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 17                                                                                                                                                                                 *DF62015019999*                                                                                                          17 
 18                                                                                                                                                                                                                         DF62015019999                                                                    18 
             CHANGES MUST BE MADE ON THE REQUEST FOR CHANGE FORM.
 19          CHECK THE BOX IF YOU ARE FILING A CHANGE FORM.                                                                                                                                                                                                                                                  19 
 20                                                                                                                                 TELEPHONE NUMBER                                                                                        DATE                                                             20 
 21                                                                                                                                 EMAIL ADDRESS                                                                                                                                                            21 
 22                                 XAUTHORIZED SIGNATURE    I declare under penalties of perjury that this is                                                                                                                                                                                               22 
                                                            a true, correct and complete form. 
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