Form 1040-Es - Estimated Tax For Individuals - Payment Voucher 2005 Page 6
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6Record of Estimated Tax Payments (Farmers, fishermen, and fiscal year taxpayers, see page 2 for payment due dates.)
(b) Check or
(c) Amount paid
Payment
(d) 2004
(e) Total amount
(a) Date
money order number or
(do not include
due
overpayment
paid and credited
paid
credit card
any credit card
date
credit applied
(add (c) and (d))
confirmation number
convenience fee)
1
4/15/2005
2
6/15/2005
3
9/15/2005
*
4
1/17/2006
Total
*
You do not have to make this payment if you file your 2005 tax return by January 31, 2006, and pay the entire balance due with your return.
Where To File Your Estimated Tax Payment Voucher if Paying by Check or Money Order
Mail your estimated tax payment voucher and
Alabama, Florida, Georgia,
All APO and FPO addresses,
P.O. Box 105225
check or money order to the Internal Revenue
Mississippi, North Carolina,
American Samoa, the
Atlanta, GA
Service at the address shown below for the
Rhode Island, South Carolina,
Commonwealth of the
30348-5225
place where you live. Do not mail your tax
West Virginia
Northern Mariana Islands,
return to this address or send an estimated
nonpermanent residents of
P.O. Box 80102
P.O. Box 105900
tax payment without a payment voucher.
Guam or the Virgin Islands,
Ohio (if mailing before
Cincinnati, OH
Atlanta, GA
Also, do not mail your estimated tax
Puerto Rico (or if excluding
July 1, 2005)
45280-0002
30348-5900
payments to the address shown in the Form
income under Internal Revenue
1040 or 1040A instructions. If you need more
Code section 933), dual-status
Alaska, Arizona, California,
aliens, a foreign country: U.S.
payment vouchers, use another Form
Hawaii, Idaho, Montana,
P.O. Box 510000
citizens and those filing Form
Nevada, Ohio (if mailing
1040-ES package.
San Francisco, CA
2555, 2555-EZ, or 4563
after June 30, 2005),
94151-5100
Note. For proper delivery of your estimated
Oregon, Utah, Virginia,
Department of Revenue
tax payment to a P.O. box, you must include
Washington, Wyoming
and Taxation
the box number in the address. Also, note
Permanent residents
Government of Guam
Connecticut, Delaware, Illinois,
that only the U.S. Postal Service can deliver
of Guam*
P.O. Box 23607
Indiana, Iowa, Kansas,
P.O. Box 970006
to P.O. boxes.
GMF, GU 96921
Michigan, Minnesota, Missouri,
St. Louis, MO
IF you live in . . .
THEN use . . .
Nebraska, North Dakota, South
63197-0006
V.I. Bureau of Internal
Dakota, Wisconsin
Permanent
Revenue
residents of the
9601 Estate Thomas
Maine, Massachusetts,
P.O. Box 37001
Arkansas, Colorado,
P.O. Box 660406
Virgin Islands*
Charlotte Amalie
New Hampshire,
Hartford, CT
Kentucky, Louisiana,
Dallas, TX
St. Thomas, VI 00802
New York, Vermont
06176-0001
New Mexico, Oklahoma,
75266-0406
Tennessee, Texas
* Permanent residents must prepare separate
District of Columbia,
P.O. Box 80102
vouchers for estimated income tax and
Maryland, New Jersey,
Cincinnati, OH
self-employment tax payments. Send the income tax
Pennsylvania
45280-0002
vouchers to the address for permanent residents
and the self-employment tax vouchers to the
address for nonpermanent residents.
Tear off here
1040-ES
4
Payment
2005
Department of the Treasury
Voucher
OMB No. 1545-0087
Internal Revenue Service
Calendar year—Due Jan. 17, 2006
File only if you are making a payment of estimated tax by check or money order. Mail this
Amount of estimated tax you are paying
voucher with your check or money order payable to the “United States Treasury.” Write your
by check or
social security number and “2005 Form 1040-ES” on your check or money order. Do not send
Dollars
Cents
money order.
cash. Enclose, but do not staple or attach, your payment with this voucher.
Your first name and initial
Your last name
Your social security number
If joint payment, complete for spouse
Spouse’s first name and initial
Spouse’s last name
Spouse’s social security number
Address (number, street, and apt. no.)
City, state, and ZIP code. (If a foreign address, enter city, province or state, postal code, and country.)
For Privacy Act and Paperwork Reduction Act Notice, see instructions on page 5.
Page 6
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