Form 1040 V Payment Voucher

2012

Form 1040-V

Department of the Treasury
Internal Revenue Service

What Is Form 1040-V

How To Prepare Your Payment

It is a statement you send with your check or money
order for any balance due on the “Amount you owe” line
of your 2012 Form 1040, Form 1040A, or Form 1040EZ.

• Make your check or money order payable to “United
States Treasury.” Do not send cash.
• 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
“2012 Form 1040,” “2012 Form 1040A,” or “2012 Form
1040EZ,” whichever is appropriate.

You can also pay your taxes online or by phone either by a
transfer from your bank account or by credit or debit
TIP direct
card. Paying online or by phone is convenient and secure
and helps make sure we get your payments on time. For
more information, go to www.irs.gov/e-pay.

How To Fill In Form 1040-V

• 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”).

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 Send In Your 2012 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 2012 tax return, payment, and Form 1040-V to
the address shown on the back that applies to you.

Form 1040-V (2012)

Cat. No. 20975C

Form

▼ Detach

1040-V

Department of the Treasury
Internal Revenue Service (99)

Print or type

1 Your social security number (SSN)

Here and Mail With Your Payment and Return ▼

Payment Voucher
▶

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

2012
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. Make your check or
money order payable to “United States
Treasury”

OMB No. 1545-0074

Last name
Apt. no.

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

Foreign postal code

Cat. No. 20975C

Page 2

Form 1040-V (2012)

IF you live in. . .

THEN use this address if you:
Are not enclosing a check or
money order . . .

Are enclosing a check or money
order . . .

Florida, Louisiana, Mississippi, Texas

Department of the Treasury
Internal Revenue Service
Austin, TX 73301-0002

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

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

Department of the Treasury
Internal Revenue Service
Fresno, CA 93888-0002

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

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

Department of the Treasury
Internal Revenue Service
Fresno, CA 93888-0002

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

Alabama, Georgia, Kentucky, Missouri, New Jersey, North
Carolina, South Carolina, Tennessee, Virginia

Department of the Treasury
Internal Revenue Service
Kansas City, MO 64999-0002

Internal Revenue Service
P.O. Box 1000
Louisville, KY 40293-1000

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

Department of the Treasury
Internal Revenue Service
Kansas City, MO 64999-0002

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 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.

Department of the Treasury
Internal Revenue Service
Austin, TX 73301-0215

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