Form 1040-Es - Estimated Tax For Individuals - 2016 Page 11
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1040-ES
2016 Estimated Tax
Payment
Department of the Treasury
Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due Sept. 15, 2016
File only if you are making a payment of estimated tax by check or money order. Mail this
Amount of estimated tax you are paying
voucher with your check or money order payable to “United States Treasury.” Write your
by check or
social security number and “2016 Form 1040-ES” on your check or money order. Do not send
Dollars
Cents
money order.
cash. Enclose, but do not staple or attach, your payment with this voucher.
Your first name and initial
Your last name
Your social security number
If joint payment, complete for spouse
Spouse’s first name and initial
Spouse’s last name
Spouse’s social security number
Address (number, street, and apt. no.)
City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.)
Foreign postal code
Foreign country name
Foreign province/county
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Tear off here
2
1040-ES
2016 Estimated Tax
Payment
Department of the Treasury
Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due June 15, 2016
File only if you are making a payment of estimated tax by check or money order. Mail this
Amount of estimated tax you are paying
voucher with your check or money order payable to “United States Treasury.” Write your
by check or
social security number and “2016 Form 1040-ES” on your check or money order. Do not send
Dollars
Cents
money order.
cash. Enclose, but do not staple or attach, your payment with this voucher.
Your first name and initial
Your last name
Your social security number
If joint payment, complete for spouse
Spouse’s first name and initial
Spouse’s last name
Spouse’s social security number
Address (number, street, and apt. no.)
City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.)
Foreign postal code
Foreign country name
Foreign province/county
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Tear off here
1
1040-ES
2016 Estimated Tax
Payment
Voucher
Department of the Treasury
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due April 18, 2016
File only if you are making a payment of estimated tax by check or money order. Mail this
Amount of estimated tax you are paying
voucher with your check or money order payable to “United States Treasury.” Write your
by check or
social security number and “2016 Form 1040-ES” on your check or money order. Do not send
Dollars
Cents
money order.
cash. Enclose, but do not staple or attach, your payment with this voucher.
Your first name and initial
Your last name
Your social security number
If joint payment, complete for spouse
Spouse’s first name and initial
Spouse’s last name
Spouse’s social security number
Address (number, street, and apt. no.)
City, state, and ZIP code. (If a foreign address, enter city, also complete spaces below.)
Foreign postal code
Foreign country name
Foreign province/county
Form 1040-ES (2016)
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
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