Form It - Montana Individual Income Tax Payment Voucher - 2012
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1
2Montana
EXT-12
Rev 03 12
2012 Extension Payment Worksheet
15-30-2604, MCA
Your First Name and Middle Initial
Last Name
Social Security Number
Spouse's First Name and Initial
Last Name
Spouse's Social Security Number
You may not need to complete this worksheet if you meet certain criteria. Please see the instructions before you begin.
Complete lines 1 through 9 to determine your 2012 filing extension payment.
1. Enter 100% of your 2011 tax liability, as reported on your 2011 Form 2, line 54;
Form 2M, line 47 or Form 2EZ, line 15 ................................................................. 1.
2. Enter your total tax liability from your 2012 Form 2, line 54; Form 2M, line 47 or
Form 2EZ, line 15. If you are not able to determine your 2012 tax liability, enter
the amount from line 1 above on line 4, then go to line 5 ..................................... 2.
3. Multiply line 2 by 90% (0.90) ................................................................................ 3.
4. Enter the smaller of line 1 or line 3 .................................................................................................... 4.
5. Enter the amount of any 2012 Montana income tax withheld and/or mineral
royalty tax withheld that is reported on federal Form(s) W-2 and 1099. (Include
any tax withheld by an S corporation or partnership reported to you on
Montana Schedule K-1.) ....................................................................................... 5.
6. Enter the amount of your 2012 estimated tax payments. (Include in this
amount, when applicable, your 2011 overpayment that was credited to 2012.) ... 6.
7. Enter the amount of your 2012 refundable credits. (This includes your elderly
homeowner/renter credit, film employment production credit, film qualified
expenditures credit, Insure Montana credit or temporary emergency lodging
credit.)................................................................................................................... 7.
8. Add lines 5, 6, and 7. This is your total payments and offsets. .................................................... 8.
9. If line 8 is greater than line 4, enter zero. You do not have to make an extension payment. If line
8 is less than line 4, subtract line 8 from line 4. this is the amount that you owe on or before
April 15, 2013, to receive an extension to file your tax return..................................................... 9.
Form-It
Montana Individual Income
Please use this voucher to ensure proper credit of
your payment. Also, write your social security number
tax Payment Voucher
and tax year on your check.
Why not e-pay? See your options at revenue.mt.gov.
1. Current Year
name ______________________________
Phone number ______________________
2. Estimated
12 31 2012
5. Period Ending Date
*12AL0101*
X
3. Extension
*12AL0101*
6. SSN
Department of Revenue
4. Amended
Po Box 6309
7. Amount Paid
Helena, Mt 59604-6309
81114030600000000000004000000000RTNPYM500000000000
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