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MISSOURI DEPARTMENT OF REVENUE
INDIVIDUAL INCOMETAX PAYMENT VOUCHER INSTRUCTIONS
WhatIsFormMO- 1040V andWhyShould I UseIt? HowDoI Make MyPayment?
FormMO-1040V, Individual Income T axPayment Vouchersthevoucher,i • Makeyourche ckormoney order payab letothe“Missour iDe partme ntof
yousendwith yourpay mentwhenyouhaveanamount dueonyour Revenue.Donotsendcash(U.S.fundsonly) . Dono t postda teyou r”
inc ometaxreturn. It issimilar tovouchers returned withloan,utility,and check; itwillbecasheduponreceipt.TheDepar tm entofRevenue may
credit cardpa yments. FormMO-1040V ensures thatyourpa yment willbe collectchecks returned forins uff icientoruncollectefunds electr onically.d
processed moreeffi ciently andaccurately.In addition, FormMO-1040V • Writeyourname,address, SS N, da ytim e telephone number, and
allowsyoutofileyou rcomple tedincom etaxreturn andsendyourpaym ent “20 09MOIncome T ax”onyourcheck ormoney order.
at a laterdate. Yourincome taxretur nandpaym entareduenolate r • Detach thepaymen t vouc herattheperforation, andmailwithyour
thanApril15,2010. payme nt.
When Should I UseFormMO-1040V? •Pleasema ilyourFormMO-1 040Vandpayment to:
If you havean am ountdue on an electronicalfiledret urn,or do notly Missouri Depa rtment ofRe venue
submitpaymen t infullwh enyoufileyourincome taxreturn , sendForm P.O.Box371
MO-1040V withyourpayme nt. Jefferson City,MO65105-0371
HowDoI Fil l InthePaym entVouc her? Pleas e printasshow n belowinblackordar k blueink.Donot
Complete thenam e(s)andaddr essblock . Usethelabelfromthefront useredinkorpencil.
cove rofyourbookiftheaddr essinfor mat iononthelabeliscorrect.
Line1— Enteryoursocialsecurity number (SS N)onLine1.Ifyouare 1 1 2 2 3 34 4 A A B B C C D D
filingacombined return, ent eronLine1thefirstSSNasshown onyour
ret urn. Federal Privacy Notice
Line2 — Enterthefirs t fourlettersof yourlastnameonLine2.See The Federal Privacy Act requires the Missouri Department of Revenue (Department) to
inform taxpayers of the Department's legal authority for requesting identifying information,
examples. including social security numbers, and to explain why the information is needed and how
NAM E ENTER the information will be used.
JohnBrown BROW Chapter 143 of the Missouri Revised Statutes authorizes the Department to request informa-
JuanDeJesus DEJE Please usecapit al tion necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section
JoanA.Lee LE E letters asshown. 405 (c)(2)(C) authorizes the states to require taxpayers to provide social security numbers.
The Department uses your social security number to identify you and process your tax
JeanMcC arthy MCCA returns and other documents, to determine and collect the correct amount of tax, to
JohnO’Neill ONEI ensure you are complying with the tax laws, and to exchange tax information with the
Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32 and
Pe droTorres- Lopez TORR 143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide information to
Line3—Ifyouarefilingacombined return, enter onLine3yourspouse’s} the Department of Higher Education with respect to applicants for financial
assistance under Chapter 173, RSMo and (2) to offset refunds against amounts due to a state
SSN. agency by a person or entity (Chapter 143, RSMo). Information furnished to other agencies
or persons shall be used solely for the purpose of administering tax laws or the specific laws
Line4— Enterthefirstfourletters ofyourspouse’s lastname onLine4. administered by the person having the statutory right to obtain it [as
Seeexamples forLine2,above. indicated above]. In addition, information may be disclosed to the public regarding the
name of a tax credit recipient and the amount issued to such recipient (Chapter 135, RSMo).
Line5— Ent ertheamount ofyourpayment inwhol edoll arsonLine5. (For the Department's authority to prescribe forms and to require furnishing of social securi-
ty numbers, see Chapters 135, 143, and 144, RSMo.)
You are required to provide your social security number on your tax return. Failure to pro-
vide your social security number or providing a false social security number may result in
criminal action against you.
MO 860-2715 (11-2009)
Reset Form Print Form
PERF
1. Social
MISSOURI DEPARTMENT OF REVENUE 2009 security number......
*
FORM
INDIVIDUAL INCOMETAX 2. Name
PAYMENT VOUCHER MO 1040V- control.............. *
PLEASE PRINT. MAKECHECKPAYABLE TO MISSOURIDEPARTMENT OF 3. Spouse ’ssocial
REVENUE. MAIL FORMMO-1040V ANDPAYMENTTO THEMISSOURI security number...... *
DEPARTMENT OF REVENUE, P.O. BOX 371, JEFFERSON CITY, MO 65105-0371.
NAME 4. Spouse ’sname
contr ol ............. *
5. Amount ofpaymen t
SPOUSE’S NAME (U.S. fundsonly)...... $ • 0 0
STREET ADDRESS
CITY STATEZIP CODE
FULL PAYMENT OF TAXES MUST BE SUBMITTED BY APRIL 15, 2010 TO AVOID
INTEREST AND ADDITIONS TO TAX FOR FAILURE TO PAY. If you pay by check, you * •
authorize the Department of Revenue to process the check electronically. Any returnedDOR USE ONLY
check may be presented again electronically.
• PLEASE SEND CHECK OR MONEY ORDER (U.S. FUNDS ONLY) *
MO 860-2715 (11-2009)
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