Individual Income Tax Payment Form - Montana Department Of Revenue Cashier

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Attention
Montana Department of Revenue Cashier
Individual Income Tax Payment Form
Complete the coupon below to ensure proper credit of your payment. If you are paying taxes for
multiple years, submit a separate check or money order and a separate coupon for each tax
year.
Boxes 1 through 5 - Print an “X” in one box only for the type of payment being remitted:
Box 1, if your payment is for the current year.
Box 5, if your payment is for an amended return.
Box 2, if your payment is for estimated tax.
Box 6, year ending date
Box 3, if your payment is for a extension payment.
Box 7, social Security Number
Box 4, if your payment is for a back year.
Box 8, amount paid
Name
Address
Phone
Mail this entire form with your check and return to:
Department of Revenue
PO Box 5805
Helena, MT 59604-5805
Questions? Call (406) 444-6900
Make checks payable to the Department or Revenue
1. Current Year
2. Estimated Tax
6. Year Ending Date
/
/
3. Extension
-
-
7. Social Security Number
4. Back Year
,
,
.
8. Amount Paid
5. Amended Tax Payment

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