Form 1040 V Payment Voucher

2011

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 2011 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.

How To Prepare Your Payment

Department of the Treasury
Internal Revenue Service

• Make sure your name and address appear on your
check or money order.
• 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
“2011 Form 1040,” “2011 Form 1040A,” or “2011 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 2011 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 2011 tax return, payment, and Form 1040-V to
the address shown on the back that applies to you.

• Make your check or money order payable to “United
States Treasury.” Do not send cash.

Form 1040-V (2011)

Cat. No. 20975C

Form

▼ Detach

1040-V

Department of the Treasury
Internal Revenue Service (99)

Payment Voucher
▶

OMB No. 1545-0074

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

Foreign country name

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

Dollars

Cents

Last name

If a joint return, spouse’s first name and initial
Home address (number and street)

3 Amount you are
paying by check or
money order

2011

Last name
Apt. no.

City, town or post office, state, and ZIP code (If a foreign address, also complete spaces below.)
Foreign province/county

Foreign postal code

Cat. No. 20975C

Page 2

Form 1040-V (2011)

IF you live in . . .

THEN use this address:

Alabama, Georgia, North Carolina, South Carolina

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

Florida, Louisiana, Mississippi, Texas

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

Alaska, Arizona, California, Colorado, Hawaii, Nevada,
Oregon, Washington

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

Arkansas, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Montana, Nebraska, New Mexico, North Dakota,
Ohio, Oklahoma, South Dakota, Utah, Wisconsin, Wyoming

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

Kentucky, Missouri, New Jersey, Tennessee, Virginia,
West Virginia

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

Connecticut, Delaware, District of Columbia, Maine, Maryland,
Massachusetts, New Hampshire, New York, Pennsylvania,
Rhode Island, Vermont

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

A foreign country, U.S. possession or territory, or use an APO or
FPO address, or file Form 2555, 2555-EZ, or 4563, or are a
dual-status alien.

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