Occupational Tax and Registration Return for Wagering

Do not staple Form 11-C(V) or your
payment to Form 11-C (or to each other).

Form 11-C(V)
Payment Voucher
Purpose of Form

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Complete Form 11-C(V), Payment Voucher, and file it
with Form 11-C, Occupational Tax and Registration
Return for Wagering. We will use Form 11-C(V) to
credit your payment more promptly and accurately,
and to improve our service to you.
If you have your return prepared by a third party,
provide Form 11-C(V) to the return preparer.

Specific Instructions
● Enter on
Form 11-C.

the

voucher

the

amount

paid

with

● Make your check or money order payable to the
“United States Treasury.” Be sure to enter your EIN,
“Form 11-C” and the tax period on your check or
money order. Do not send cash. Please do not staple
your payment to Form 11-C(V) or the return or to each
other.
● Detach Form 11-C(V) and send it with your payment
and Form 11-C to the address on page 2. Do not send
a photocopy of Form 11-C(V); your payment may be
misapplied or delayed.
If any of the preprinted information is incorrect, make
changes on the top of Form 11-C, not on Form
11-C(V). If you change any of the preprinted
information on the voucher, your payment may be
misapplied or delayed.

Detach here

Department of the Treasury
Internal Revenue Service
●
●
●

OMB No. 1545-0236
(Rev. April 2008)

Use this voucher when making a payment with your Form 11-C.
Do not staple this voucher or your payment to Form 11-C.
Make your check or money order payable to the “United States
Treasury.”

Form 11-C(V) Payment Voucher
Enter the amount of
your payment.

Dollars

Cents

3