INDIVIDUAL E-FILE RETURN PAYMENT VOUCHER                                                     Form ND-1V
               OFFICE OF STATE TAX COMMISSIONER
               SFN 28726 (12-2021)
                                                                                                            2021

What is Form ND-1V?                                                 Only a check drawn on a U.S. or Canadian bank in U.S. 
Form ND-1V is a form you complete and send in with                  dollars and using a standard 9-digit routing number is 
a check or money order to pay a balance due on an                   accepted.
electronically filed North Dakota individual income tax 
return. You may also pay a balance due electronically—see           Electronic payment option. Instead of paying by check or 
“Electronic payment option.”                                        money order with this payment voucher, the payment may 
                                                                    be made online with an electronic check or a debit or credit 
Do not use Form ND-1V to make an extension 
                                                                    card. The electronic check option is free. North Dakota 
payment. Extension payments should be made using the 
                                                                    contracts with a national payment service to provide the 
extension payment voucher, Form ND-1EXT.
                                                                    debit or credit card option, for which there is a fee, none 
                                                                    of which goes to the State of North Dakota. If paying 
When is the payment due?
                                                                    electronically, do not use this voucher.
The payment must be made on or before April 15, 2022, 
to avoid any late payment penalty or interest. This applies         To make an electronic payment, go to
even if you have not received acknowledgement that your             www.nd.gov/tax/payment.
electronic North Dakota return was accepted.
                                                                    Need help?
How to make payment                                                 Phone:  701-328-1242
If paying by check or money order, make the check or                            Speech or hearing impaired—
money order payable to “ND State Tax Commissioner,”                             800-366-6888
and write last four digits of social security number and            Email:  individualtax@nd.gov
“2021 ND-1V” on check or money order. Complete the 
payment voucher, detach it from this page, and mail it with         Privacy Act Notification. In compliance with the Privacy Act of 1974, 
                                                                    disclosure of a social security number or Federal Employer Identification 
the check or money order to:                                        Number (FEIN) on this form is required under N.D.C.C. §§ 57-01-15 
                                                                    and 57-38-31, and will be used for tax reporting, identification, and 
  Office of State Tax Commissioner                                  administration of North Dakota tax laws. Disclosure is mandatory. Failure 
                                                                    to provide the social security number or FEIN may delay or prevent the 
  PO Box 5622                                                       processing of this form.
  Bismarck, ND 58506-5622

                                   ▼ Detach here and mail with payment ▼

FORM ND-1V  INDIVIDUAL E-FILE RETURN PAYMENT VOUCHER                                                        2021
North Dakota Office of State Tax Commissioner
SFN 28726 (12-2021)
Do not use this voucher if paying electronically
Name
                                                                    Social Security
                                                                    Number . . . . . . . . . . . . .►
Spouse's Name
                                                                    Spouse's Social
                                                                    Security Number . . . . . ►
Mailing Address

City, State, ZIP Code
                                                                    Payment Amount  ► $
Mail payment and voucher to:  Office of State Tax Commissioner      • Make payable to:
                                            PO Box 5622               ND State Tax Commissioner
                                            Bismarck, ND 58506-5622 • Write last four digits of             ND-1V
                                                                     social security number and
                                                                     "2021 ND-1V" on check