Form 1040 V Payment Voucher

2010

Form 1040-V

What Is Form 1040-V and Do You Have To
Use It?
It is a statement you send with your check or money
order for any balance due on the “Amount you owe” line
of your 2010 Form 1040, Form 1040A, or Form 1040EZ.
Using Form 1040-V allows us to process your payment
more accurately and efficiently. We strongly encourage
you to use Form 1040-V, but there is no penalty if you do
not.

How To Fill In Form 1040-V
Line 1. Enter your social security number (SSN). If you are
filing a joint return, enter the SSN shown first on your
return.
Line 2. If you are filing a joint return, enter the SSN shown
second on your return.
Line 3. Enter the amount you are paying by check or
money order.
Line 4. Enter your name(s) and address exactly as shown
on your return. Please print clearly.

Department of the Treasury
Internal Revenue Service

• Enter your daytime phone number and your SSN on
your check or money order. If you are filing a joint return,
enter the SSN shown first on your return. Also enter
“2010 Form 1040,” “2010 Form 1040A,” or “2010 Form
1040EZ,” whichever is appropriate.
• To help us process your payment, enter the amount on
the right side of your check like this: $ XXX.XX. Do not
use dashes or lines (for example, do not enter “$ XXX—”
or “$ XXX xx/100”).

How To Send In Your 2010 Tax Return,
Payment, and Form 1040-V
• Detach Form 1040-V along the dotted line.
• Do not staple or otherwise attach your payment or Form
1040-V to your return or to each other. Instead, just put
them loose in the envelope.
• Mail your 2010 tax return, payment, and Form 1040-V to
the address shown on the back that applies to you.

How To Prepare Your Payment
• Make your check or money order payable to the “United
States Treasury.” Do not send cash.
• Make sure your name and address appear on your
check or money order.

Form 1040-V (2010)

Cat. No. 20975C

Form

▼ Detach

1040-V

Department of the Treasury
Internal Revenue Service (99)

Payment Voucher
▶

Do not staple or attach this voucher to your payment or return.

1 Your social security number (SSN)

Print or type

Here and Mail With Your Payment and Return ▼

2 If a joint return, SSN shown second
on your return

4 Your first name and initial
If a joint return, spouse’s first name and initial

3 Amount you are
paying by check
or money order

OMB No. 1545-0074

2010

Dollars

Cents

Last name
Last name

Home address (number and street)

Apt. no.

City, town or post office, state, and ZIP code (If a foreign address, enter city, province or state, postal code, and country.)

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 20975C

Page 2

Form 1040-V (2010)

IF you live in . . .

THEN use this address:

Florida or Georgia

Internal Revenue Service
P.O. Box 105017
Atlanta, GA 30348-5017

Alabama, Kentucky, Louisiana, Mississippi, Tennessee, Texas

Internal Revenue Service
P.O. Box 1214
Charlotte, NC 28201-1214

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Nevada,
New Mexico, Oregon, Utah, Washington, Wyoming

Internal Revenue Service
P.O. Box 7704
San Francisco, CA 94120-7704

Arkansas, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota,
Montana, Nebraska, North Dakota, Oklahoma, South Dakota,
Wisconsin

Internal Revenue Service
P.O. Box 802501
Cincinnati, OH 45280-2501

Delaware, District of Columbia, Maryland, Missouri, Ohio, Rhode
Island, Virginia, West Virginia

Internal Revenue Service
P.O. Box 970011
St. Louis, MO 63197-0011

Connecticut, Maine, Massachusetts, New Hampshire, New
Jersey, New York, North Carolina*, Pennsylvania, South Carolina*,
Vermont

Internal Revenue Service
P.O. Box 37008
Hartford, CT 06176-0008

A foreign country, American Samoa, or Puerto Rico (or are
excluding income under Internal Revenue Code section 933), or
use an APO or FPO address, or file Form 2555, 2555-EZ, or 4563,
or are a dual-status alien or nonpermanent resident of Guam or
the Virgin Islands**

Internal Revenue Service
P.O. Box 1303
Charlotte, NC 28201-1303 USA

* If you live in North Carolina or South Carolina, and are filing after June 30, 2011, use: Internal Revenue Service, P.O. Box 105017, Atlanta, GA 30348-5017.
** Permanent residents of Guam or the Virgin Islands should not use Form 1040-V.