Free A-115 2009 Prepayment form - Wisconsin

State of Wisconsin

l

DEPARTMENT OF REVENUE
2135 RIMROCK ROAD l MAIL STOP 3-164 l PO BOX 8903 l MADISON WI 53708-8903 FAX (608) 264-6884 l www.revenue.wi.gov

If you wish to prepay 100% of your 2009 income tax, complete the estimated tax voucher below and mail this entire form postmarked by December 31, 2008 with your prepayment to: Wisconsin Department of Revenue Exceptions Resolutions Unit Mail Stop 3164 PO Box 8903 Madison WI 537088903 Check this box if you want a "Certificate of Exemption from Withholding," form W200, to give your employer. You will receive 2 copies of this form.

2009 PREPAYMENT
Last name First name Spouse's last name First name

ESTIMATED TAX
Social security number Social security number

Home address (number and street or rural route)

Telephone number

City or post office

State

Zip code

Prepayment Amount
A-115 (R. 11-08)

$