INDIVIDUAL PAPER RETURN PAYMENT VOUCHER                                                Form ND-1PRV
                OFFICE OF STATE TAX COMMISSIONER
                SFN 28756 (12-2021)
                                                                                                       2021

What is Form ND-1PRV?                                                  Office of State Tax Commissioner
The 2021 Form ND-1PRV is a payment voucher that you                    PO Box 5621
complete and send in with your return if you:                          Bismarck, ND 58506-5621

●  are filing your 2021 Form ND-EZ or Form ND-1 on                   Only a check drawn on a U.S. or Canadian bank in U.S. 
 paper,                                                              dollars and using a standard 9-digit routing number is 
●  have a balance due on your return, and                            accepted.

●  are paying the balance due with a paper check or money 
                                                                     Electronic payment option. Instead of paying by check 
 order.
                                                                     or money order with this payment voucher, the payment 
Do not use Form ND-1PRV if you filed or are going                    may be made online with an electronic check or a debit 
to file your return electronically, or are paying 
                                                                     or credit card. The electronic check option is free. North 
a balance due electronically - see “Electronic 
payment option.”                                                     Dakota contracts with a national payment service to 
                                                                     provide the debit or credit card option, for which there is 
Also do not use this form to make an extension 
payment; instead, if you have an extension of time                   a fee, none of which goes to the State of North Dakota. If 
to file your Form ND-1 and you want to make an                       paying electronically, do not use this voucher. To make an 
advance payment of an expected balance due on it,                    electronic payment, go to www.nd.gov/tax/payment.
use Form ND-1EXT.
                                                                     Need help?
When is the payment due?                                             Phone:  701-328-1242
A balance due on a 2021 Form ND-EZ or 2021                                       Speech or hearing impaired - 800-366-6888
Form ND-1 must be paid on or before April 15, 2022, to               Email:  individualtax@nd.gov
avoid any late payment penalty and interest charges.

How to make payment                                                  Privacy Act Notification. In compliance with the Privacy Act of 1974, 
                                                                     disclosure of a social security number or Federal Employer Identification 
Make your check or money order payable to “ND State                  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 
Tax Commissioner.” Write the last four digits of your                administration of North Dakota tax laws. Disclosure is mandatory. Failure 
social security number and “2021 ND-1PRV” on your                    to provide the social security number or FEIN may delay or prevent the 
                                                                     processing of this form.
check or money order. Complete the payment voucher, 
detach it from this page, and mail it with your payment 
and return to:

                                          ▼ Detach here and mail with payment ▼

 FORM ND-1PRV  INDIVIDUAL PAPER RETURN PAYMENT VOUCHER                                                 2021
 North Dakota Office of State Tax Commissioner
 SFN 28756 (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 5621               ND State Tax Commissioner
                                             Bismarck, ND 58506-5621 • Write last four digits of      ND-1PRV
                                                                      social security number and
                                                                      "2021 ND-1PRV" on check