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44 Cut along dotted line 44
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Form North Dakota Office of State Tax Commissioner
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50 ST Sales, Use, and Gross Receipts Tax Payment Voucher 10174901 50
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53 NAMEASSHOWNONFORMST 53
54 MAILINGADDRESS Account Number 99999900 54
55 ADDITIONALADDRESS 55
56 CITY STATE ZIP Period Ending MM/DD/YYYY 56
57 COUNTRYIF<>USA 57
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60 Amount of Payment $ 999999999 60
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-Make check or money order payable to "North Dakota State Tax Commissioner"
NACTP -Mail to: State Tax Commissioner, PO Box 5623, Bismarck ND 58506-5623 SLS
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