▼ Detach here and mail with payment ▼

FORM 40-EPV  CORPORATION ELECTRONIC RETURN PAYMENT VOUCHER 
North Dakota Office of State Tax Commissioner
SFN 28725 (12-2021)
                                                                                                              2021
Do not use this voucher if paying electronically
Name Of Corporation As It Will Appear On Form 40
                                                                       Federal Employer
                                                                       Identification Number . . . ►
Mailing Address
                                                                       Tax Year Beginning
                                                                       (mm/dd/yyyy) . . . . . . . . ►
City, State, ZIP Code
                                                                       Tax Year Ending
                                                                       (mm/dd/yyyy) . . . . . . . . ►

                                                                       Payment Amount  ► $

• Due 15th day of 4th month following end of tax year                           • Make payable to:
• Mail payment and voucher to:  Office of State Tax Commissioner                  ND State Tax Commissioner
                                               600 E. Boulevard Ave., Dept. 127                               CIT
                                                                                  Write "2021 40-EPV" on check
                                               Bismarck, ND 58505-0599          •