Form Ccv - Credit Card Payment Voucher - Idaho

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Form CCV
8734
Credit Card Payment Voucher
TC0003
7-27-04
Credit Card Account # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date __ __ /__ __ __ __
Payment $
Billing Address for the Credit Card
Street
City
State
Zip
Name of Card Holder
Contact Name
Daytime Telephone
Taxpayer Name or Business Name if different from Credit Card Holder
This payment is for:
•
•
Individual Income Tax - Tax Year Ending MO ___ ___
YR ___ ___
Permit Based Tax - Tax Period Ending MO ___ ___ YR ___ ___
Primary SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Business EIN ___ ___ - ___ ___ ___ ___ ___ ___ ___
•
Spouse’s SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Sales Tax Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
•
•
Business Income Tax - Tax Year Ending MO ___ ___
YR ___ ___
Withholding Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
•
Business EIN ___ ___ - ___ ___ ___ ___ ___ ___ ___
____________ Tax Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
Authorized Signature
Date
Check applicable box.
Discover
MasterCard
VISA
CUT HERE
Return this voucher only if you are making a payment by credit card.
You can use your MasterCard, VISA, or Discover card to pay any Idaho taxes you owe.
You may pay the balance due or make an extension payment, pay estimated taxes, or
pay amounts owed for prior years.
To make a payment by credit card, attach this form to the front of the tax return and mail
to the address indicated on the return. If you want to mail your payment separately, mail
this form to:
Idaho State Tax Commission
P O Box 83784
Boise ID 83707-3784

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