1. State of Wisconsin DEPARTMENT OF REVENUE
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2135 RIMROCK ROAD MAIL STOP 3-164 PO BOX 8903 l MADISON WI 53708-8903
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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 3‑164
PO Box 8903
Madison WI 53708‑8903
Check this box if you want a “Certificate of Exemption from Withholding,” form W‑200, to give your
employer. You will receive 2 copies of this form.
2009 PREPAYMENT ESTIMATED TAX
Last name First name Social security number
Spouse’s last name First name 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)