Form Nd-1ext - Individual Extension Payment Voucher
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1North Dakota Offi ce of State Tax Commissioner
Form
ND-1EXT
Individual Extension Payment
2015
Purpose
How to make payment
For more information and to make an
electronic payment, go to our website
If you are applying for an extension of
If paying by check or money
at
time to fi le your 2015 North Dakota
order, make the check or money
individual income tax return, you may
order payable to “ND State Tax
Need help?
make an extension payment to prepay
Commissioner,” and write last four
the tax that you expect to owe to avoid
digits of social security number(s) and
Phone: 701.328.1247
paying extension interest.
“2015 ND-1EXT” on check or money
Speech or hearing impaired—
order. Complete the payment voucher
800.366.6888
If you make an extension payment,
below, detach it from this page, and
Email: individualtax@nd.gov
you must fi le Form ND-1 and claim
mail it with the check or money order
the payment on page 2, line 27; you
to:
Privacy Act Notifi cation. In compliance
may not fi le Form ND-EZ.
with the Privacy Act of 1974, disclosure of a
Offi ce of State Tax Commissioner
social security number or Federal Employer
Identifi cation Number (FEIN) on this form is
PO Box 5622
The payment must be made no later
required under N.D.C.C. §§ 57-01-15 and
Bismarck, ND 58506-5622
57-38-31, and will be used for tax reporting,
than April 15, 2016, to avoid extension
identifi cation, and administration of North
interest.
Dakota tax laws. Disclosure is mandatory.
Only a check drawn on a U.S. or
Failure to provide the social security number or
FEIN may delay or prevent the processing of
Canadian bank in U.S. dollars and
this form.
Important. Do not use
using a standard 9-digit routing
Form ND-1EXT if you:
number is accepted.
• Choose to make the payment
Record of payment
electronically—see “How to make
Electronic payment option. Instead
Record the payment here and place in
payment” for your payment options.
of paying by check or money order
your 2015 tax records
• File your return on or before
with this payment voucher, the
April 15, 2016.
payment may be made online with a
Date of payment: ______________
• Pay your balance due after April 15,
debit or credit card or electronic check.
2016.
North Dakota contracts with a national
Check number: ______________
payment service to provide this option.
If you fi le your return after April 15,
There is a fee for this service, none
Amount paid: ______________
2016, any tax paid with the return is
of which goes to the State of North
subject to extension interest.
Dakota. If paying electronically, do
not use this voucher.
Detach here and mail with payment
ND-1EXT
Form ND-1EXT Individual Extension Payment Voucher
North Dakota Office of State Tax Commissioner
2015
28713
Extension Payment (#5)
Due April 15, 2016
DO NOT use this voucher if paying electronically
Name (first, middle initial and last)
Your social security number
Spouse's social security number
Spouse's name (first, middle initial and last)
Mailing address
Amount of payment
City, state and ZIP code
For Tax
Department
use only
Make check or money order payable to "ND State Tax Commissioner."
•
Write last four digits of social security number(s) and "2015 ND-1EXT"
•
on check or money order.
Mail to: Office of State Tax Commissioner, PO Box 5622, Bismarck, ND
IIT
•
58506-5622
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