| Massachusetts Tax |
| Taxpayer Name: | ||
| Taxpayer ID: | ||
| Taxpayer Verification: | ||
| Payment Amount: | ||
| Zero Tax Due: | ||
| Receiving Bank ID: | ||
| Receiving Bank Acct. No.: | ||
| Last Payment Date: | ||
| Hold Transfer: | ||
| Tax Period End Date: | ||
| Tax Type Code: |
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| Create Prenote: | ||
| Prenote Date | ||
| Company Account No.: | ||
| Account Type: | Checking Savings | |