Fillable Form Mo-1041v - Fiduciary Income Tax Payment Voucher

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Missouri Department of Revenue

Form

2013 Fiduciary Income Tax Payment Voucher

MO-1041V

The MO-1041V voucher is used if you have an amount

How do I make my payment?

due on an electronically filed return, or you do not submit

• Attach a check or money order payable to the “Missouri

payment in full when you file your Fidicuary Income Tax

Department of Reve nue.” Do not send cash (U.S. funds

Return

(Form

MO-1041). Your Fiduciary Income Tax

only). The Department of Revenue may collect checks

Return and payment are due no later than the 15th day

returned for insufficient or uncollected funds electronically.

of the fourth month following the end of the income tax

• Write the name of the estate or trust, address, Federal

year. Do not use Form MO-1041V for making extension

Employer Identification Number, daytime telephone

payments, please use the Application for Extension of Time

number, and “2013 MO Fiduciary Income Tax” on your

to File

(Form

MO-60).

check or money order. Do not postdate your check; it

Complete the voucher in its entirety to ensure the payment

will be cashed upon receipt.

is applied to the correct account and tax period. On Line 1,

• Detach the payment voucher at the dotted line and

the payment must be entered in whole dollars and match

mail with your payment to the address listed on Form

the amount of the check.

MO-1041V.

Full payment of taxes must be submitted by April 15, 2014 to avoid interest and addition to tax for failure to pay. If you

pay by check, you authorize the Department of Revenue to process the check electronically. Any returned check may be

presented again electronically.

Please print as shown below in

black or dark blue ink.

1 2 3 4 5 6 7 8 9 0

Federal Privacy Notice

The Federal Privacy Act requires the Missouri Department of Revenue (Department) to inform taxpayers of the Department’s legal authority for requesting identifying information, including social security

numbers, and to explain why the information is needed and how the information will be used.

Chapter 143 of the Missouri Revised Statutes authorizes the Department to request information necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section 405 (c)(2)(C)

authorizes the states to require taxpayers to provide social security numbers.

The Department uses your social security number to identify you and process your tax returns and other documents, to determine and collect the correct amount of tax, to

ensure you are complying with the tax laws, and to exchange tax information with the Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32

and 143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide information to the Department of Higher Education with respect to applicants for financial

assistance under Chapter 173, RSMo and (2) to offset refunds against amounts due to a state agency by a person or entity (Chapter 143, RSMo). Information furnished to other

agencies or persons shall be used solely for the purpose of administering tax laws or the specific laws administered by the person having the statutory right to obtain it [as

indicated above]. In addition, information may be disclosed to the public regarding the name of a tax credit recipient and the amount issued to such recipient (Chapter 135, RSMo). (For the Department’s

authority to prescribe forms and to require furnishing of social security numbers, see Chapters 135, 143, and 144, RSMo.)

You are required to provide your social security number on your tax return. Failure to provide your social security number or providing a false social security number may result in criminal action against

you.

Missouri Department of Revenue

Form

2013 Fiduciary Income Tax Payment Voucher

MO-1041V

1. Amount of payment

Federal Employer Identification Number

Taxable Year Ending (MM/DD/YYYY)

Due Date (MM/DD/YYYY)

(U.S. funds only) ...............

__ __ /__ __ /__ __ __ __

Name of Estate or Trust