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Get IN DoR E-6 2011

Umber Indiana Taxpayer Identification Number Location Check If This Is for a New Estimated Account Check if new address A. Name of Corporation or Organization A B. Street B C. City C D. State E. ZIP Code F. Indiana County H. Tax Year Ending (month & year) D E F H Month Year If you are remitting a payment with this form, indicate quarter and amount paid: $ Quarter Amount (Enter 1, 2, 3, 4, or 5) Make check payable (in U.S. funds) to Indiana Department of Revenue Check one option.

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