Memorandum Assessment of Estimated State Income Tax for Taxable Year
Total Page：16
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Form 559 COMMONWEALTH OF VIRGINIA
County or City of , Virginia Declaration Number
MEMORANDUM ASSESSMENT OF ESTIMATED STATE INCOME TAX FOR TAXABLE YEAR
Declaration Payment Received Voucher (First Payment received for taxable year) FOR USE BY THE COMMISSIONER Amount Number (mm/dd/yyyy) Form Preparation Date (mm/dd/yyyy)
Primary Social Security Number Secondary Social Security Number FOR USE BY THE TREASURER Amount
FEIN (For Estate or Trust)
Fiscal Year: Beginning Date Ending Date
VA Dept of Taxation 2604014 (Rev 09/06)
Form 559 COMMONWEALTH OF VIRGINIA
County or City of , Virginia Declaration Number
MEMORANDUM ASSESSMENT OF ESTIMATED STATE INCOME TAX FOR TAXABLE YEAR
Declaration Payment Received FOR USE BY THE COMMISSIONER Voucher (First Payment received for taxable year) Amount Number (mm/dd/yyyy) Form Preparation Date (mm/dd/yyyy)
Primary Social Security Number Secondary Social Security Number FOR USE BY THE TREASURER Amount
FEIN (For Estate or Trust)
Fiscal Year: Beginning Date Ending Date
VA Dept of Taxation 2604014 (Rev 09/06)