Form 1040-Es - Estimated Tax For Individuals - 2016 Page 9

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Record of Estimated Tax Payments (Farmers, fishermen, and fiscal
year taxpayers, see Payment Due Dates.)
Keep for Your Records
(c) Check or
(d) Amount paid
Payment
(e) 2015
(f) Total amount
(a) Amount
(b) Date
money order number, or
(do not include
due
overpayment
paid and credited
due
paid
credit or debit card
any convenience
date
credit applied
(add (d) and (e))
confirmation number
fee)*
1
4/18/2016
2
6/15/2016
3
9/15/2016
4
1/17/2017**
Total.
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* You can deduct the convenience fee charged by the service provider in 2016 as a miscellaneous itemized deduction (subject to the 2%-of-AGI
limit) on your 2016 income tax return.
** You do not have to make this payment if you file your 2016 tax return by January 31, 2017, and pay the entire balance due with your return.
Privacy Act and Paperwork Reduction Act Notice. We ask for this
We may disclose it to cities, states, the District of Columbia, and U.S.
information to carry out the tax laws of the United States. We need it to
commonwealths or possessions to carry out their tax laws. We may also
figure and collect the right amount of tax. Our legal right to ask for this
disclose this information to other countries under a tax treaty, to federal
information is Internal Revenue Code section 6654, which requires that
and state agencies to enforce federal nontax criminal laws, or to federal
you pay your taxes in a specified manner to avoid being penalized.
law enforcement and intelligence agencies to combat terrorism.
Additionally, sections 6001, 6011, and 6012(a) and their regulations
If you do not file a return, do not give the information asked for, or
require you to file a return or statement for any tax for which you are
give fraudulent information, you may be charged penalties and be
liable; section 6109 requires you to provide your identifying number.
subject to criminal prosecution.
Failure to provide this information, or providing false or fraudulent
Please keep this notice with your records. It may help you if we ask
information, may subject you to penalties.
you for other information. If you have any questions about the rules for
You are not required to provide the information requested on a form
filing and giving information, please call or visit any Internal Revenue
that is subject to the Paperwork Reduction Act unless the form displays
Service office.
a valid OMB control number. Books or records relating to a form or its
The average time and expenses required to complete and file this
instructions must be retained as long as their contents may become
form will vary depending on individual circumstances. For the estimated
material in the administration of any Internal Revenue law. Generally, tax
averages, see the instructions for your income tax return.
returns and return information are confidential, as stated in Code section
6103.
If you have suggestions for making this package simpler, we would be
happy to hear from you. See the instructions for your income tax return.
We may disclose the information to the Department of Justice for civil
and criminal litigation and to other federal agencies, as provided by law.
Tear off here
4
1040-ES
2016 Estimated Tax
Payment
Department of the Treasury
Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due Jan. 17, 2017
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
cash. Enclose, but do not staple or attach, your payment with this voucher.
money order.
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.
-9-

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