Form 1040ext-Me - Extension Payment Voucher For Individual Income Tax 2002
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1Line 35b. Underpayment Penalty.
Line 35c. Total Amount Due.
(do not staple or tape)
Sample Check
1234
THIRD PARTY DESIGNEE.
15000000000
123 Main St
Anyplace, ME 04000
______________ 20 ______
PAY TO THE
ORDER OF ________________________________________ $
_________________________________________________ DOLLARS
include
Anyplace, ME 04000
the check number
____________________________
For _________________________________
I
250250025
202020” ‘ 86 ” ’ 1234
NOTE: Use the form below only if you are making a payment.
*020091000*
2002
STATE OF MAINE
1040EXT-ME
EXTENSION PAYMENT VOUCHER
for INDIVIDUAL INCOME TAX
*020091000*
YOUR FIRST NAME
INITIAL YOUR LAST NAME
YOUR SOCIAL SECURITY NUMBER
-
-
NOTE:
SPOUSE’S FIRST NAME
INITIAL SPOUSE’S LAST NAME
SPOUSE’S SOCIAL SECURITY NUMBER
-
-
ADDRESS (NUMBER and STREET)
AMOUNT OF PAYMENT
,
.
$
CITY
STATE
ZIP CODE
If you make a payment using this
voucher, you must use a Long Form
(1040ME) when you file your return.
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