Form Ext-09 - Extension Payment Worksheet - 2009 Page 2
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1
2Montana Individual Income tax
(81)
Payment Instructions
Attention: Montana Department of Revenue Cashier
Complete the information below to ensure proper credit of your payment.
Name __________________________________________________________________
Mailing Address __________________________________________________________
__________________________________________________________
City, State, Zip Code ______________________________________________________
Phone ____________________________
Instructions
Box 5 –
Enter the tax year for which this payment applies (period ending date).
Box 6 –
Enter your social security number (SSN).
Box 7 –
Enter the amount you paid.
You can pay your extension payment electronically by e-check or credit card. Please visit our website at revenue.mt.gov
under Online Services for Individuals. There is no fee for an e-check payment; a small fee is applied for a credit card
payment.
If paying by personal check, money order, or cashier's check, please use this voucher. Make your check payable to the
Montana Department of Revenue. Please sign your check, and write your social security number and Tax Year 2009-EXT
on the memo line.
Mail this form with your payment to:
Department of Revenue
PO Box 6308
Helena, MT 59604-6308
Questions? Please call us toll free at (866) 859-2254 (in Helena, 444-6900).
Montana Individual Income tax
Payment Form
Substitute Form IT
month
day
year
5. Period ending
/
/
6. Social security
number (SSN)
X 3. Extension
7. Amount paid
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