Form 1040n-V - Nebraska Individual Income Tax Payment Voucher 2001
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1FORM 1040N-V
Nebraska Individual Income Tax
ne
2001
Payment Voucher
dep
of
nebraska
PLEASE DO NOT WRITE IN THIS SPACE
department
of revenue
N
E
B
Name(s)
R
Street or Other Mailing Address
Apartment No.
Your Social Security Number
Spouse’s Social Security No.
A
City
State
Zip Code
Amount Remitted
Daytime Phone Number
S
(
)
K
Use only when making payment for an electronically filed return.
The total amount of tax due must be paid in full.
A
If payment is not made on or before April 15, 2002, the tax due is subject to penalty and interest.
Have questions? Check our Web site: or call 1-800-742-7474 (in Lincoln, call 471-5729).
Mail this voucher and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 98903, LINCOLN, NE 68509-8903
8-549-2001
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