Form Ia 1040xv - Amended Income Tax Payment Voucher printable pdf download

Form Ia 1040xv - Amended Income Tax Payment Voucher

Iowa Department of Revenue

Iowa Amended Individual Income Tax

Payment Voucher and Instructions

ePay (direct debit) through eFile & Pay is FREE!

If you are amending a current year tax return,

use ePay instead of mailing a check!

If you owe additional tax,

send this voucher and your payment to:

Iowa Department of Revenue

Iowa Income Tax - Document Processing

PO Box 9187

Des Moines, Iowa 50306-9187

Make check payable to Treasurer - State of Iowa.

Enclose payment with your voucher - DO NOT STAPLE to the IA 1040XV

If the amended payment is for the current tax year,

and payment is made after April 30,

the tax due may be subject to penalty and interest.

Amended payments for prior tax years

may also be subject to penalty and interest.

Iowa Department of Revenue

IA 1040XV

Amended Income Tax Payment Voucher

Mail to:

Iowa Income Tax

Iowa Department of Revenue

PO Box 9187

Des Moines, IA 50306-9187

FOR TAX YEAR ______________

PRINT name (last, first, middle initial)

Social Security Number

Spouse's name (last, first, middle initial)

Spouse's Social Security Number

Address (number and street, including apartment)

Payment Amount

City, State, ZIP

Daytime Telephone Number

(

)

*1341121019999*

Make check payable to: Treasurer - State of Iowa

When you pay by check, you authorize the Department of Revenue to convert

your check to a one-time electronic banking transaction.

41-121 (11/20/13)

Form Ia 1040xv - Amended Income Tax Payment Voucher