DO NOT WRITE OR STAPLE IN THIS AREA
1. Social Security Number
if a joint return
4. Spouse’s Social Security Number
2. First four letters of your last name
3. Amount of the payment you are making
5. Name(s)
Address
City Zip CodeState
DF21421019999
DF21421019999
DETACH HERE AND MAIL TOP PORTION WITH YOUR PAYMENT
2021
DELAWARE DIVISION OF REVENUE
Electronic Filer Payment Voucher
Individual Form 200-V
$
(Rev 09/2021
)
Mail To:
Delaware Division of Revenue
P.O. Box 830
Wilmington, DE 19899-0830
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