Form 2290-V Payment Voucher

Schedule 1 (Form 2290) (Rev. 7-2014)

Consent to Disclosure of Tax Information
For the period July 1, 2014, through June 30, 2015
By signing, dating, and entering my employer identification number below, I hereby consent to the
Internal Revenue Service (IRS) disclosing information about my payment of the heavy highway
vehicle use tax (HVUT) for the tax period listed above to the federal Department of Transportation
(DOT), U.S. Customs and Border Protection (CBP), and to state Departments of Motor Vehicles
(DMV). The information disclosed to the DOT, CBP, and state DMVs will be my vehicle identification
number (VIN) and verification that I have paid the HVUT. The IRS may disclose the information to the
DOT, CBP, and to the DMVs of the 50 states and the District of Columbia who have other taxing,
registration, or information collecting authority. I agree that the American Association of Motor
Vehicle Administrators (AAMVA), a third-party nonprofit organization, may be used as an
intermediary to transmit my VIN and payment information from the IRS to the state DMVs.
I understand that the information to be disclosed is generally confidential under the laws
applicable to the IRS and that the agency receiving the HVUT information is not bound by these laws
and may use the information for any purpose as permitted by other federal laws and/or state law. To
be effective, this consent must be received by the IRS within 120 days of the date below.
If signed by a corporate officer or party other than the taxpayer, I certify that I have the authority to
execute this consent to disclosure of tax information.
Sign
Here

a

a
Date

Signature

a
Type or print name below signature.

–
Employer identification number
Schedule 1 (Form 2290) (Rev. 7-2014)

Form 2290-V, Payment Voucher
Purpose of Form
Complete Form 2290-V if you are making a payment by
check or money order with Form 2290, Heavy Highway
Vehicle Use Tax Return. We will use Form 2290-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 and a
payment is required, provide Form 2290-V to the return
preparer.
Do not file Form 2290-V if you are paying the balance
due on Form 2290, line 6, using the Electronic Federal
Tax Payment System (EFTPS) or electronic funds
withdrawal (direct debit). See How to Pay the Tax in the
Instructions for Form 2290.

Box 2. Enter the amount paid from Form 2290, line 6.
Box 3. Enter the date as shown on Form 2290, line 1.
Box 4. Enter your name and address as shown on Form
2290.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 2290,” and the tax period on your check or money
order. Do not send cash. Do not staple Form 2290-V or
your payment to Form 2290 (or to each other).
• Detach Form 2290-V and send it with your payment and
Form 2290 to the address shown in the bottom left corner
of Form 2290-V.

Specific Instructions
Box 1. If you do not have an EIN, you may apply for one
online. Go to the IRS website at
www.irs.gov/businesses/small and click on the “Employer
ID Numbers (EINs)” link. You may also apply for an EIN by
calling 1-800-829-4933, or you can fax or mail Form
SS-4, Application for Employer Identification Number, to
the IRS.

Form

c Detach

2290-V

Payment Voucher
For the period July 1, 2014, through June 30, 2015
a See How To Pay the Tax in the Instructions for Form 2290.
a Do not staple or attach this voucher or your payment to your return.

(Rev. July 2014)
Department of the Treasury
Internal Revenue Service
1

Employer identification number

3

Enter date as shown on line 1 of Form 2290.

2

Enter the amount of your payment. Make
your check or money order payable to
“United States Treasury”

4

Name

–
Y

Y

Y

here c

Y

M

M
Address (number, street, and room or suite no.)

Send Form 2290, this voucher, and payment to:
Internal Revenue Service
P.O. Box 804525
Cincinnati, OH 45280-4525

City or town, state or province, country, and ZIP or foreign postal code

OMB No. 1545-0143

Dollars

Cents