Fillable Form Mo-1040v - Individual Income Tax Payment Voucher

MISSOURI DEPARTMENT OF REVENUE

INDIVIDUAL INCOME TAX PAYMENT VOUCHER INSTRUCTIONS

What Is Form MO-1040V and Why Should I Use It?

How Do I Make My Payment?

Form MO-1040V, Individual Income Tax Payment Voucher, is the voucher

• Make your check or money order payable to the “Missouri Department of

you send with your payment when you have an amount due on your

Revenue.” Do not send cash (U.S. funds only). Do not postdate your

income tax return. It is similar to vouchers returned with loan, utility, and

check; it will be cashed upon receipt. The Department of Revenue may

credit card payments. Form MO-1040V ensures that your payment will be

collect checks returned for insufficient or uncollected funds electronically.

processed more efficiently and accurately. In addition, Form MO-1040V

• Write your name, address, SSN, daytime telephone number, and

allows you to file your completed income tax return and send your payment

“2010 MO Income Tax” on your check or money order.

at a later date. Your income tax return and payment are due no later

• Detach the payment voucher at the perforation, and mail with your

than April 18, 2011.

payment.

When Should I Use Form MO-1040V?

• Please mail your Form MO-1040V and payment to:

If you have an amount due on an electronically filed return, or do not

Missouri Department of Revenue

submit payment in full when you file your income tax return, send Form

P.O. Box 371

MO-1040V with your payment.

Jefferson City, MO 65105-0371

How Do I Fill In the Payment Voucher?

Please print as shown below in black or dark blue ink. Do not

}

Complete the name(s) and address block. Use the label from the front

use red ink or pencil.

cover of your book if the address information on the label is correct.

1 1 2 2

3 3 4 4

A A B B C C

D D

Line 1 — Enter your social security number (SSN) on Line 1. If you are

filing a combined return, enter on Line 1 the first SSN as shown on your

return.

Federal Privacy Notice

Line 2 — Enter the first four letters of your last name on Line 2. See

The Federal Privacy Act requires the Missouri Department of Revenue (Department) to

inform taxpayers of the Department's legal authority for requesting identifying information,

examples.

including social security numbers, and to explain why the information is needed and how

NAME

ENTER

the information will be used.

John Brown

BROW

Chapter 143 of the Missouri Revised Statutes authorizes the Department to request informa-

Please use capital

Juan De Jesus

DEJE

tion necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section

405 (c)(2)(C) authorizes the states to require taxpayers to provide social security numbers.

letters as shown.

Joan A. Lee

LEE

The Department uses your social security number to identify you and process your tax

Jean McCarthy

MCCA

returns and other documents, to determine and collect the correct amount of tax, to

John O’Neill

ONEI

ensure you are complying with the tax laws, and to exchange tax information with the

Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32 and

Pedro Torres-Lopez

TORR

143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide information to

Line 3 — If you are filing a combined return, enter on Line 3 your spouse’s

the Department of Higher Education with respect to applicants for financial

assistance under Chapter 173, RSMo and (2) to offset refunds against amounts due to a state

SSN.

agency by a person or entity (Chapter 143, RSMo). Information furnished to other agencies

or persons shall be used solely for the purpose of administering tax laws or the specific laws

Line 4 — Enter the first four letters of your spouse’s last name on Line 4.

administered

the

person

having

the

statutory

right

obtain

[as

See examples for Line 2, above.

indicated above]. In addition, information may be disclosed to the public regarding the

name of a tax credit recipient and the amount issued to such recipient (Chapter 135, RSMo).

Line 5 — Enter the amount of your payment in whole dollars on Line 5.

(For the Department's authority to prescribe forms and to require furnishing of social securi-

ty numbers, see Chapters 135, 143, and 144, RSMo.)

You are required to provide your social security number on your tax return. Failure to pro-

vide your social security number or providing a false social security number may result in

criminal action against you.

Reset Form

Print Form

MO 860-2715 (09-2010)

1. Social

2010

MISSOURI DEPARTMENT OF REVENUE

security number . . . . . .

FORM

INDIVIDUAL INCOME TAX

2. Name

MO-1040V

PAYMENT VOUCHER

control . . . . . . . . . . . . . .

3. Spouse’s social

PLEASE PRINT. MAKE CHECK PAYABLE TO MISSOURI DEPARTMENT OF

security number . . . . . .

REVENUE.

MAIL FORM MO-1040V AND PAYMENT TO THE MISSOURI

DEPARTMENT OF REVENUE, P.O. BOX 371, JEFFERSON CITY, MO 65105-0371.

4. Spouse’s name

NAME

control . . . . . . . . . . . . .

5. Amount of payment

0 0

SPOUSE’S NAME

•

(U.S. funds only) . . . . . .

STREET ADDRESS

CITY

STATE

ZIP CODE

FULL PAYMENT OF TAXES MUST BE SUBMITTED BY APRIL 18, 2011 TO AVOID

•

INTEREST AND ADDITIONS TO TAX FOR FAILURE TO PAY. If you pay by check, you

DOR USE ONLY

authorize the Department of Revenue to process the check electronically. Any returned

check may be presented again electronically.

• PLEASE SEND CHECK OR MONEY ORDER (U.S. FUNDS ONLY)

MO 860-2715 (09-2010)

Form Mo-1040v - Individual Income Tax Payment Voucher - 2010

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