Form K-40es - Kansas Individual Estimated Income Tax Voucher

Form K-40es - Kansas Individual Estimated Income Tax Voucher - 2012 Page 6

K-40ES

2012 KANSAS

FOR OFFICE USE ONLY

Please use UPPER CASE letters

INDIVIDUAL ESTIMATED INCOME

to print the first four letters of

(Rev. 8/11)

TAX VOUCHER

Your last name

Spouse's last name

If married filing joint, include both names and social security numbers (SSNs).

Last Name

Initial

Taxpayer's First Name

Your Social

Initial

Last Name

Spouse's First Name

Security number

Spouse's Social

Security number

Mailing Address (Number and Street, including Rural Route)

Name or

Address

4TH QUARTER PAYMENT DUE

City, Town, or Post Office

State

Zip Code

Change

JANUARY 15, 2013

Daytime Phone Number

Write your SSN(s) on your check or money order and make payable to

"Kansas Individual Estimated Tax." Mail to: Estimated Tax, Kansas

PAYMENT

Department of Revenue, 915 SW Harrison St., Topeka KS 66625-2000.

AMOUNT

DO NOT SUBMIT PHOTOCOPIES OF THIS FORM

181012

Form K-40es - Kansas Individual Estimated Income Tax Voucher - 2012 Page 6